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MASSAGE 

AND  THE 

ORIGINAL  SWEDISH  MOVEMENTS 


OSTROM 


MASSAGE 

AND  THE 

ORIGINAL  SWEDISH  MOVEMENTS 

THEIR  APPLICATION  TO  VARIOUS 
DISEASES  OF  THE  BODY 


Lectures  before  the  Training  Schools  for  Nurses  Connected  with 
the1  Hospital  of  the  University  of  Pennsylvania.^German  Hos- 
pital,   Woman's   Hospital,  "Philadelhhia   Lying-in   Charity 
Hospital,    the    Philadelphia    Polyclinic   and    College 
for  Graduates  in   Medicine,  and  the   Kensing- 
ton Hospital  for  Women,  of  Philadelphia 


BY 

KURRE  W.  OSTROM 

FROM   THE   ROYAL   UNIVERSITY   OF   UPS  ALA,   SWEDEN 


EIGHTH  EDITION,  REVISED  AND  ENLARGED 

WITH  ONE  HUNDRED  AND  TWENTY-FIVE  ILLUSTRATIONS 


PHILADELPHIA 

P.  BLAKISTON'S  SON  &  CO. 

1012  WALNUT  STREET 


00 


Copyright,  1918,  by  P.  Blakiston's  Son  &  Co. 


/ 


THE  MAPLE  PRESS  YORK  PA 


PREFACE  TO  THE  EIGHTH  EDITION 


The  revision  of  this  book  was  undertaken  at  the 
request  of  the  publishers,  who  stipulated  that  the 
notes  left  by  the  late  Mr.  Ostrom  should  be  followed 
as  much  as  possible.  This  has  been  done,  except 
in  the  case  of  the  notes  on  dislocations,  which  I 
have  preferred  not  to  use.  With  the  permission  of 
the  publishers  I  have  written  the  article  on  disloca- 
tions from  my  own  viewpoint. 

This  revision  consists  mainly  in  the  additional 
suggestions  on  treatment,  with,  here  and  there, 
some  modification  of  statement  made  necessary  by 
later  experience.  Beyond  this,  the  original  text 
has  not  been  changed — That  is  to  say,  that,  where 
the  late  author's  method  of  treatment  or  practice 
differed  but  slightly  from  mine,  then  no  change  will 
be  found. 

There  are  sixteen  entirely  new  pictures  in  this 
edition,  which  were  made  under  the  personal  direc- 
tion of  Mr.  Ostrom  just  before  his  rather  sudden 
death.  Some  of  the  old  figures  in  the  text  have  been 
altered,  redrawn  or  enlarged  in  accordance  with  his 
wishes. 


31WG14 


VI  PREFACE 

The  conciseness  of  this  book  makes  it  particularly 
valuable  to  beginners,  who  need  to  learn  those  es- 
sentials that  constitute  the  foundation  for  study  and 
practice  of  this  important  branch  of  the  healing  art. 

P.    SlLFVERBERG,    G.    D. 


PREFACE  TO  THE  FIRST  EDITION 


As  the  tendency  of  modern  therapeutics  is  to  cure 
disease  by  the  application  of  the  laws  of  hygiene, 
the  author  feels  that  in  presenting  this  little  work 
to  the  medical  profession,  and  to  those  especially 
interested  in  the  subject,  he  will  be  supplying  in 
English  a  treatise  that  has  long  been  needed. 

It  is  true,  several  books  have  been  written  on  this 
subject  by  physicians,  but  none  of  them  has  been 
sufficiently  explicit  in  telling  how  to  perform  the 
various  manipulations,  or  the  cases  which  may  be 
benefited  by  the  movements. 

This  work  endeavors  to  explain  how  the  move- 
ments are  to  be  applied  to  all  parts  of  the  body, 
and  also  to  show  for  what  diseases  such  movements 
are  indicated. 

I  am  very  much  indebted  to  Drs.  Charles  K.  Mills 
and  H.  Augustus  Wilson  for  their  kindness  in  giving 
me  ample  opportunity  to  practically  demonstrate 
the  Swedish  methods  of  massage  and  movements 
at  the  Philadelphia  Polyclinic  and  College  for 
Graduates  in  Medicine. 

I  am  also  under  obligations  to  several  other  pro- 

vii 


Vlll  PREFACE 

fessors  of  the  same  institution  for  valuable  informa- 
tion received. 

In  describing  the  various  movements  and  their 
influence  upon  the  different  parts  of  the  body, 
I  have  consulted  such  well-known  Swedish  authors 
as  Wretlind,  Hartelius,  Kleen,  etc. 

It  is  hoped  that  this  little  text-book  will  be  a 
practical  and  valuable  addition  to  what  has  already 
been  published  on  the  subject  of  mechanotherapy. 

The  Author. 


CONTENTS 

Page 

Introduction i 

Exercise  in  Therapeutics 4 

Massage 8 

Massage  as  a  Therapeutic  Agent 20 

Pressing  and  Shaking  (Vibrations) 54 

Details  of  Treatment 60 

Contraindications  for  Massage 61 

Swedish  Movements 63 

Positions 63 

Divisions  of  Movements 76 

The  Various  Movements 77 

The  Physiology  of  the  Movement  Treatment 107 

Mechanical  Action  of  Muscles 112 

Application  of  Massage,  etc.,  to  Various  Diseases  of  the  Body.  116 

General  Weakness 117 

Anemia 117 

Hysteria 119 

Chorea 119 

Plethora 120 

Insomnia 120 

Headaches 121 

Apoplexy 124 

Infantile  Paralysis. 126 

Tabes : .  .  129 

Neuralgia 131 

Neuritis 134 

Progressive  Muscular  Atrophy 135 

Writer's  Cramp 136 

Splanchnic  Neurasthenia 136 

Affections  of  the  Respiratory  Organs 138 

Catarrh  of  the  Lungs 138 

Pharyngitis  and  Laryngitis 139 

Consumption 139 

Bronchitis,  Nervous  Asthma,  etc. 140 

ix 


X  CONTENTS 

Page 

Colds 140 

Diseases  of  the  Heart 142 

Diseases  of  the  Digestive  Organs 145 

Dyspepsia ■ 145 

Habitual  Constipation 146 

Hemorrhoids 150 

Obesity 151 

Enlargement  of  the  Liver 152 

Diabetes 153 

Uterine  Affections 154 

Amenorrhea 154 

Dysmenorrhea 155 

Affections  of  the  Bladder : 155 

Rheumatism 156 

Lumbago 157 

Stiff  Neck 158 

Gout 158 

Lateral  Curvature  of  the  Spine 159 

Sprains 169 

Dislocations 170 

Synovitis 1 73 

Varicose  Veins 174 

Hernia 175 

Fractures 176 

Deformities  of  the  Feet 178 

Affections  of  the  Eye 180 

Affections  of  the  Ear 181 

General  Remarks 183 

The  Massage  Treatment  in  America 185 

Bibliography 189 

Index 193 


MASSAGE 


AND 


THE  SWEDISH  MOVEMENTS 


INTRODUCTION 

Manual  treatment  for  disease  has  to  a  certain 
extent  existed  since  the  creation.  Man  had,  by 
instinct,  acquired  the  art  of  manipulation  long 
before  nature  yielded  her  secrets  in  medicine. 
This  is  still  the  practice  among  many  nations. 
Tn  Sweden,  even  at  the  present  time,  certain  ma- 
nipulations are  used  among  the  peasants  for  cramps, 
swellings,  etc.  The  Swedes  seem  never  to  have  lost 
the  art — but  recently  revived  in  other  countries. 

Amiot  and  Dally  speak  of  a  perfect  system  of 
gymnastics  among  the  Chinese  three  thousand 
years  before  the  Christian  era.  They  maintained 
that  gymnastics,  by  preventing  stagnation,  produced 
an  even  and  harmonious  movement  of  the  fluids  in 
the  human  body,  which  is  necessary  to  health.  Not 
only  did  they  use  gymnastics  to  preserve  health,  but 
they  also  had  a  thorough  knowledge  of  their  thera- 
peutic effects.  From  each  of  the  natural  positions 
they  placed  the  body  and  limbs  in  certain  derivative 


2  MASSAGE 

positions,  which  modified  the  movement  of  the  fluids 
and  were,  of  course,  important  in  different  diseases. 

The  priests  of  Egypt  used  some  manipulation 
in  the  form  of  kneading  and  friction  for  rheumatic 
pains,  neuralgias,  and  swellings. 

The  Hindoos,  also,  had  some  knowledge  of  their 
therapeutic  importance;  but  the  masses  were  soon 
mystified  by  the  priests,  who  by  incantations  and 
magical  words,  led  them  to  believe  they  were  in- 
vented by  the  gods. 

Even  the  Persians  used  a  few  movements  for 
different  affections. 

The  Greeks  were  the  first  to  recognize  gymnastics 
as  an  institution — a  fact  of  much  importance  to  the 
free  states.  Here  they  were  auxiliary  to  the  de- 
velopment of  the  people  both  socially  and  politically. 
The  gymnasts  were  political,  pedagogic,  esthetic, 
and  therapeutic.  The-  philosophers  and  the  physi- 
cians recommended  manual  treatment.  Plato  even 
divided  it  into  active  and  passive  movements, 
and  especially  recommended  the  latter.  .Some 
physicians  practised  the  movements  themselves; 
but  there  arose  a  class  of  people,  called  Pddotribes, 
some  of  whom  acquired  great  skill  in  the  manipula- 
tion of  the  human  body. 

Although  the  Romans  imitated  the  Greeks  to 
some  extent,  they  rather  preferred  calisthenics; 
yet  the  manual  method  was  more  extensively 
practised  in  Rome  under  the  emperors  than  it  had 
hitherto  been  by  any  other  nation. 


MASSAGE  •  3 

Thus  we  see  that  among  the  ancients  the  most 
common  movements  were  a  few  passive  manipula- 
tions, while  in  the  Middle  Ages  the  gymnastics  of 
an  earlier  period  were  more  or  less  forgotten. 

In  the  fifteenth  and  sixteenth  centuries  well- 
known  physicians  recommended  gymnastics.  Fuller 
and  Tissot  wished  to  combine  the  movements  with 
the  study  of  medicine.  In  the  early  part  of  the  last 
century  a  therapeutic  system  of  gymnastics  acquired 
a  reputation  heretofore  unknown,  in  movements 
based  upon  a  certain  action  between  operator  and 
patient. 

The  Swede,  P.  H.  Ling  (i 776-1839),  and  his 
predecessors,  erected  the  first  scientific  system, 
in  which  they  adopted  the  new  medical  science, 
making  the  movement  treatment  a  perfectly  scien- 
tific remedy,  worthy  of  the  confidence  of  every 
educated  man. 

In  our  own  time,  Dr.  Mezger,  of  Wiesbaden, 
has  demonstrated  certain  passive  movements,  and 
arranged  them  into  a  system  that  is  now  indorsed 
by  every  intelligent  physician. 


EXERCISE  IN  THERAPEUTICS 


In  walking  or  riding,  or  even  in  some  of  the 
ordinary  occupations  of  life,  it  is  true  that  a  person 
takes  a  certain  amount  of  exercise,  but  there  is  no 
method  in  such  movements. 

It  is  easy  to  determine  how  much  is  to  be  done 
and  how  long  it  may  be  continued,  but  it  will  be  a 
very  difficult  matter  to  estimate  the  amount  of  vital 
force  necessary  to  carry  these  exercises  into  execution. 

For  instance,  in  walking,  the  strength  of  the 
motion  depends  not  only  upon  the  time  and  speed 
used,  but  also  upon  the  weight  of  the  body,  sup- 
ported by  the  lower  extremities.  In  many  cases 
the  strength  and  tone  of  the  muscles  of  the  leg  are 
not  in  proportion  to  the  weight  of  the  body. 

This  condition  is  exemplified  in  most  of  the 
calisthenic  exercises. 

When  a  person  is  practising  calisthenics,  the 
strength  of  the  exercise  depends  upon  the  con- 
stitution and  upon  the  weight  and  the  natural 
activity  of  the  body,  which  are  not  necessarily  in 
proportion  to  the  individual's  strength. 

For  instance  in  jumping;  to  a  person  weighing 
one  hundred  pounds  the  exercise  may  be  only  light 
and    agreeable,  whereas  to  another,  weighing  two 

4 


MASSAGE  5 

hundred  pounds,  the  weight  of  whose  body  is  out  of 
proportion  to  the  muscular  strength,  the  same  exer- 
cise might  prove  positively  injurious. 

Not  being  able  to  estimate  the  vital  force  used 
in  the  common  exercises  practised  under  the  head 
of  calisthenics,  or  in  the  different  sports  or  games, 
they  should  not  be  classified  under  the  name  of 
Medical  or  Remedial  Gymnastics.  In  the  latter 
case  it  is  necessary  to  be  able  to  estimate  the  amount 
of  force  required  in  every  movement,  and  apply  it 
according  to  the  strength  of  each  individual. 

The  difference  between  the  Movement  Treat- 
ment and  the  common  exercise  does  not  consist 
only  in  the  quantitative  estimate  of  the  movements. 

In  the  exhilarating  exercise  of  riding  the  motion 
is  general,  acting  upon  the  entire  body,  no  part 
being  excepted.  On  the  other  hand,  in  walking  or 
dancing  the  muscles  of  the  legs  are  used  almost 
exclusively,  those  of  the  arms  not  being  brought 
into  action  at  all.  The  dancing-master  has  well- 
developed  muscles  in  his  legs,  whereas,  unless  he 
resorts  to  some  special  exercise  for  his  arms,  their 
muscles  will  not  be  in  proportion  to  those  of  the  legs. 

Persons  of  sedentary  habits,  especially  dress- 
makers and  clerks,  who  have  but  little  exercise  of 
any  kind,  are  sure  to  have  an  ill-developed  muscular 
system.  Unless  such  persons  take  exercise  system- 
atically, they  are  liable  to  injure  themselves 
severely.  Persons  who  try  to  excel  in  any  one  kind 
of  athletics  run  great  risks  of  exceeding  their  strength. 


6  MASSAGE 

Thus  we  see  it  is  impossible  to  estimate  the  benefit 
of  calisthenics,  which  can  easily  be  done  with  the 
Swedish  movements. 

Finally,  in  the  movement  treatment,  all  move- 
ments are  arranged  in  such  a  way  and  in  such  a  form 
as  to  be  comfortable  and  adapted  to  all  parts  of  the 
body. 

Based  upon  a  knowledge  of  the  anatomy  and 
physiology  of  the  parts,  and  of  their  proper  physio- 
logic limits,  this  treatment  is  much  superior  to  any 
other,  as  well  as  more  agreeable. 

All  joints  have  a  natural  motion  within  certain 
fixed  limits.  When  such  joints  are  gently  exercised, 
an  agreeable  sensation  is  produced;  but  if  the  exer- 
cise be  too  violent, — flexing,  extending,  or  rotating 
to  excess, — severe  pains  will  probably  result.  The 
same  may  be  said  of  the  muscular  system.  Each 
muscle  having  a  distinct  and  certain  function  to 
perform,  proper  exercise  of  these  muscles,  if  confined 
to  physiologic  limits,  will  be  invigorating  and  agree- 
able to  the  patient. 

In  giving  the  Swedish  movements  special  atten- 
tion is  directed  to  the  natural  functions  of  joints 
and  muscles.  This  is  not  the  case  with  any  other 
kind  of  exercise,  consequently  the  sensation  and 
value  of  promiscuous  movements  can  never  be  the 
same. 

When  movements  are  necessary  over  painful 
parts  of  the  body,  the  patient  must  sometimes 
judge  how  much  he  can  bear. 


MASSAGE  7 

An  operator  who  is  not  able  to  explain  the 
physiologic  action  of  every  manipulation  or  move- 
ment he  uses  is  liable  to  do  more  harm  than  good 
to  the  patients. 

The  Swedish  movement  treatment  can  better  adapt 
itself  to  all  conditions  than  any  other  treatment. 

Finally,  the  aim  of  the  Swedish  treatment  is,  by 
a  careful  manipulation  of  muscles  and  joints,  to  re- 
store to  good  health  such  as  are  in  any  way  diseased. 
The  force  of  such  manipulations  can  be  estimated  and 
the  extent  of  their  duration  fixed. 


MASSAGE 

The  word  Massage  is  a  derivation  from  the 
Greek  massein,  or  the  French  masser,  which  both 
mean :  to  knead.  A  male  operator  is  called  a  masseur, 
a  female  operator,  a  masseuse. 

Massage  is  a  scientific  treatment,  by  certain  pas- 
sive systematic  manipulations,  upon  the  nude  skin  of 
the  human  body. 

Dr.  Mezger,  of  Amsterdam  (now  practising  in 
Wiesbaden,  Germany),  and  his  two  pupils,  the 
Swedish  physicians  Berghman  and  Helleday,  were 
among  the  first  to  apply  the  massage  treatment 
scientifically.  Their  method  is  now  used  throughout 
Europe.  According  to  Mezger,  massage  is  a  scien- 
tific treatment — i.e.,  based  upon  the  anatomy  and 
the  physiology  of  the  human  body;  his  manipulations 
are  certain — that  is,  given  or  fixed,  so  that  an  un- 
instructed  person  can  not  pick  up  the  treatment — it 
is  an  art  that  can  not  be  self-acquired;  all  manipula- 
tions are  passive — i.e.,  applied  to  the  patient  without 
his  assistance  or  resistance;  the  manipulations  are 
also  systematic — i.e.,  they  are  arranged  so  as  to  act 
systematically  upon  the  different  tissues  of  the 
human  body. 

8 


MASSAGE  9 

Dr.  Mezger  divides  the  massage  treatment  into 
four  principal  manipulations: 
i.  Effleurage. 

2.  Frictions. 

3.  Petrissage. 

4.  Tapotement. 


Fig.   1. — Stroking  with  One  Hand. 

i.  EFFLEURAGE  (STROKING) 

This  manipulation  consists  of  centripetal  {toward 
the  body  or  heart)  Strokings. 

It  is  performed  in  four  different  ways: 
(a)  Stroking  with  the  palm  of  one  hand. 
(a)  Stroking  with  the  palms  of  both  hands. 

(c)  Stroking  with  the  thumb. 

(d)  Stroking  with  the  tips  of  the  fingers. 
Stroking  with  the  One  Hand  (see  Fig.  1)  is 

used  upon  the  extremities,  the  back  of  the  head,  and 
in  single  massage  of  the  neck  (Gerst's  method). 


10 


MASSAGE 


Stroking  with  Both  Hands  is  used  upon  the 
lower  extremities  of  adults,  upon  the  chest  (see 
Fig.  2)  and  back,  also  in  double  massage  of  the 
neck. 


Fig.   2. — Stroking  with  Both  Hands. 


Stroking  with  the  Thumb  (see  Fig.  3)  is  used 
between  two  muscles,  or  between  a  muscle  and  a 
tendon;  also  frequently  to  reach  the  inter ossei  in 
the  hands  and  the  feet. 


MASSAGE 


II 


Stroking  with  the  Tips  of  the  Fingers  (see 
Fig.  4),  or  the  last  two  phalanges,  is  principally 


Fig.  3. — Stroking  with  the  Thumb. 

used  around  the  joints  (in  cases  of  sprains,  etc.), 
the  fingers  conforming  themselves  to  the  shape  of 
the  part  to  be  worked  upon. 


Fig.  4. — Stroking  with  the  Tips*  of  the  Fingers. 

The    strength  *  of    the  "  manipulation,     stroking, 
varies   from   the^slightest^touch   to   the   strongest 


12 


MASSAGE 


Fig.  5. — Friction  with  the  Thumb. 


Fig.  6. — Friction  with  the  Tips  of  the  Fingers. 


MASSAGE 


13 


pressure;  even  with  one  hand  on  top  of  the  other,  if 
necessary. 

The  aim  of  all  Strokings  is  to  increase  the  circula- 
tion in  the  venous  blood-vessels  and  the  lymphatics, 
thereby  causing  absorption. 


Fig.   7. — Kneading  with  the  Two  Thumbs. 


2.  FRICTIONS  (FRICTION) 

Are  firm,  circular  manipulations,  always  followed  by 
centripetal  strokings.  As  a  rule,  they  are  performed 
over  one  group  of  muscles  at  a  time. 


14 


MASSAGE 


Friction  is  given  in  three  different  ways: 

(a)  Friction  with  the  thumb. 

(b)  Friction  with  the  tips  of  the  fingers. 

(c)  Friction  with  the  one  hand. 

Friction  with  the  Thumb  (see  Fig.  5)  is  used 
upon  the  extremities,  but  also  upon  smaller  surfaces; 
as,  for  instance,  around  the  knee-joints  and  upon  the 
facial  muscles  (see  Fig.  113). 


Fig.   8. — Kneading   on   the    Hand,    for    Contracted.  Tendons   and 

Muscles. 


Friction  with  the  Tips  of  the  Fingers  is 
used  around  the  joints,  the  thumb  often  supporting 
the  hand  (see  Fig.  6).  The  circles  are  sometimes 
made  a  great  deal  smaller  than  demonstrated  in 
Fig.  6. 

Friction  with  the  One  Hand  is  used  upon 
the  larger  surfaces  and  fleshier  parts,  like  the 
thigh,    arm    proper,    and    lumbar    region    of    back. 


MASSAGE 


15 


All  Frictions  should  be  centripetal,  and  should 
always  be  followed  by  centripetal  strokings,  as 
the  aim  of  this  manipulation  is  to  transform  patho- 
logically   changed   parts    into    a    condition    that    will 


Fig.  9. — Kneading  (Petrissage;  of  Biceps. 

permit  them  to  be  incorporated  into  the  healthy  tissues, 
and  thence  be  absorbed  by  the  veins  and  lymphatics. 

3.  PETRISSAGE  (KNEADING) 

This  manipulation  is  performed  in  such  a  manner 
as  to  cause  a  double  centripetal  pressure  on  a  tissue 


i6 


MASSAGE 


(muscle  or  tendon),  at  the  same  time  raising  it  up 
from  its  normal  point  of  attachment. 
We  have  three  different  kinds  of  Petrissage : 

(a)  Kneading  with  the  two  thumbs. 

(b)  Kneading  with  the  thumb  and  fingers. 


Fig.  io. — Kneading  with  Both  Hands. 

(c)   Kneading  with  the  two  hands. 

Kneading  with  the  Two  Thumbs  (see  Figs.  7 
and  8)  is  used  to  reach  individual  muscles. 

Kneading  with  the  Thumb  and  Fingers, 
which  manipulation  is  called  Pinching   (see  Fig. 


MASSAGE 


17 


9),  is  also  used  to  reach  individual  muscles,  but  is 
preferred  on  a  deep-seated  tissue. 


Fig.   11. — Clapping  of  the  Leg. 


Fig.  12. — Position   of    Hands   in    Hacking. 

Kneading  with  Both  Hands,  called  Squeezing, 
is  used  upon  the  lower  extremities,  and  upon  the 
arm  proper  (see  Fig.  10)  of  adults. 


i8 


MASSAGE 


The  aim  of  the  manipulation  Kneading  is  to 
reach  the  separate  muscles  with  a  firm  double  pres- 
sure and  expose  them  to  an  action  similar  to  that  of 
Friction. 

4.  TAPOTEMENT  (PERCUSSION) 

This  manipulation  is  always  performed  by  the 
operator's  wrist,  the  hands  striking  quickly. 


Fig.   13. — Position  of  Hands  in  Punctation  of  the  Forehead. 

We   have   four   different   kinds    of  Percussion: 

(a)  Clapping  (see  Fig.  11)  is  performed  with 
the  palms  of  the  hands.  It  is  used  to  act  upon  the 
skin  and  the  superficial  nerves  and  vessels. 

In  clapping  it  is  advisable  to  spread  a  towel  over 
the  skin  to  avoid  stinging. — (Editor). 

(b)  Hacking    (see    Fig.    12)    is   performed   with 


MASSAGE 


19 


the  ulnar  border  of  the  hand.     It  is  used  around 
nerve  centers  and  upon  the  muscles. 

(c)  Punctation  (see  Fig.  13)  is  performed  with 
the  tips  of  the  ringers.  It  is  used  upon  the  head  and 
in  circles  around  the  heart. 


Fig.   14. — Beating  over  the  Sciatic   Nerve. 

(d)  Beating  (see  Fig.  14)  is  performed  by  the 
clenched  hand.  It  is  used  upon  the  glutei  and  upon 
the  lower  extremities  over  the  sciatic  nerve. 


MASSAGE  AS  A  THERAPEUTIC 
AGENT 

is  divided  into  Introductory,  General  and  Local. 

INTRODUCTORY  MASSAGE 

In  many  affections  it  is  necessary  to  commence 
the  operation  of  massage  with  what  has  been  termed 
introductory  treatment. 

In  the  majority  of  cases  of  both  acute  and  chronic 
affections  of  the  joints  it  is  well  to  apply  the  treat- 
ment to  the  neighborhood  of  the  part,  and  especially 
above  it.  This  is  essential  if  the  skin  is  abraded  or 
if  a  severe  inflammation  of  the  part  exists  rendering 
it  sensitive  to  too  much  pain  from  pressure. 

The  treatment  consists  of  centripetal  strokings 
(with  one  or  both  hands)  in  connection  with  a  few 
kneadings. 

Special  attention  should  be  paid  to  the  inside 
parts  of  the  extremities  where  the  principal  veins 
and  lymphatics  pass.  If  possible  and  convenient, 
always  try  to  get  the  aid  of  gravity  by  elevation. 

By  this  treatment  we  prepare  the  venous  and 
lymphatic  systems  to  absorb  the  diseased  particles 
subsequently  expelled  from  the  affected  part. 

If  for  instance  we  have  a  case  of  synovitis  of  the 


20 


MASSAGE  21 

knee-joint  we  commence  by  stroking  the  inside 
part  of  the  thigh,  slightly  elevating  the  lower  part 
of  the  extremity  so  as  to  get  the  aid  of  gravity. 
The  introductory  massage  in  treating  circulatory 
and  nervous  affections  of  the  head  consists  of 
Hoefiinger's  method  of  massage  of  the  neck  so  as  to 
procure  a  free  outlet  for  the  venous  blood  from 
the  head. 

In  the  treatment  of  hemorrhoids  by  massage 
we  should  always  commence  by  treating  the  liver, 
thereby  procuring  an  outlet  for  the  congested  blood 
of  the  abdomen  through  the  portal  vein.  When 
taken  in  time  massage  is  really  a  specific  in  the 
treatment  of  hemorrhoids. 

This  is  mentioned  only  to  emphasize  the  im- 
portance of  the  introductory  massage  in  all  manual 
treatment.  The  success  of  massage  used  in  joint 
affections  will  often  depend  upon  how  well  and  how 
judiciously  the  introductory  treatment  is  applied. 

GENERAL  MASSAGE 

By  general  massage  we  mean  the  treatment 
applied  to  the  whole  body,  with  the  exception  of 
the  head. 

The  operator  begins  with  the  foot,  stroking 
with  one  hand  or  kneading  with  the  thumbs.  Then 
he  proceeds  with  the  legs,  the  arms,  the  chest,  the 
abdomen,  and  finally  the  back.  All  the  manipula- 
tions may  be  used,  and  special  attention  should  be 


2  2  MASSAGE 

given  to  the  hacking.  Some  authors  advise  to 
first  take  the  extremities,  then  the  back,  and  finally 
the  neck  and  abdomen  (Kleen  and  others).  With 
this  treatment  we  generally  combine  a  few  passive 
rotations  or  flexions,  similar  to  those  recommended 
for  anemia.  The  patient  must  be  lying  in  bed, 
well  covered  on  those  parts  not  operated  upon.  It 
is  of  advantage  for  the  operator  10  begin  with  the 
left  foot  and  leg,  and  then  have  the  patient  turn  over 
to  the  other  side  of  the  bed,  where  the  balance  of  the 
treatment  may  be  convenient!    performed. 

In  regard  to  the  time  necessary  to  spend  in  giving 
general  massage,  I  would  advise  the  operator  to 
begin  with  thirty  minutes,  and  gradually  increase 
the  time  so  that  one  hour  is  consumed  at  the  end 
of  the  first  week.  The  length  and  the  severity  of 
the  treatment  should  always  be  regulated  by  the 
patient's  condition.  General  massage  should  not  be 
employed  until  two  hours  have  elapsed  after  meals. 
As  soon  as  a  part  is  operated  upon  it  should  be 
covered  up  at  once. 

LOCAL  MASSAGE 

By  local  massage  we  mean  the  treatment  applied 
to  the  different  parts  of  the  body  at  one  time;  for 
instance,  massage  of  the  shoulder. 

I.  MASSAGE  OF  THE  LEG 

Position. — The  patient  is  lying  or  half  lying  on  a 
bed  or  couch.  The  operator  sitting  at  his  side  per- 
forms the  following  manipulations: 


MASSAGE  23 

i.  Stroking  of  the  foot  sole  and  dorsum;  quick 
stroking  with  the  palm  of  the  hand  to  the  sole  of  the 
foot  finishing  with  firm  and  quick  clappings  with  one 
hand,  the  other  grasping  the  ankle  underneath,  so 
as  to  elevate  the  limb. 

2.  Stroking  with  both  hands  from  the  ankle  to 
the  hip,  the  hand  on  the  outside  reaching  up  to  the 
crest  of  the  ilium,  the  thumb  of  the  hand  on  the 
inside,  with  moderate  pressure,  going  down  toward 
the  groin.     (Avoid  pressure  upon  the  tibia.) 

3.  Friction  with  the  thumb  upon  the  outside  of 
the  leg  from  ankle  to  knee-joint,  covering  prin- 
cipally the  flexors  of  the  foot. 

4.  Stroking  with  one  hand  of  the  same  part. 

5.  Friction  with  the  thumb  upon  the  inside 
and  posterior  part  of  the  leg,  covering  principally 
the  gastrocnemius  and  the  soleus. 

6.  Stroking  with  one  hand  of  the  same  part. 

7.  Friction  with  the  thumb  or  hand  upon  the 
outside,  inside  and  the  back  part  of  the  thigh,  divid- 
ing it  into  four  distinct  parts  so  as  to  thoroughly 
work  upon  all  the  different  muscles. 

8.  Repeated  strokings  over  the  whole  extremity, 
from  ankle  to  hip. 

9.  Kneading  with  the  two  thumbs  or  both  hands 
upon  the  different  muscles  of  the  whole  extremity. 

10.  Hacking  or  clapping  upon  the  whole  extremity, 
avoiding  the  bones. 

In    certain    cases    (dropsy,    rheumatism,    etc.), 


24  MASSAGE 

it  is  well  to  have  the  limb  elevated,  thereby  pro- 
moting the  return  of  the  venous  blood. 

The  limb  should  be  frequently  turned,  so  that 
the  posterior  part  may  receive  proper  attention. 

II.  MASSAGE  OF  THE  ARM 

Position. — The  patient  is  sitting  or  lying,  with 
the  semiflexed  arm  supported,  if  convenient.  The 
operator  sits  at  the  side. 

i.  Stroking  with  one  hand  on  the  outside  of 
the  arm,  from  the  wrist  to  the  trapezius.  The 
other  hand  should  support  around  the  wrist,  but 
care  should  be  taken  that  no  pressure  be  used 
over  the  radial  artery,  as  that  checks  circulation 
considerably. 

2.  Stroking  with  the  other  hand  upon  the  inside 
of  the  arm,  from  wrist  to  shoulder-joint,  the  thumb 
going  out  toward  the  pectoral  muscles.  Support 
is  given  in  a  similar  manner  as  described  in  i. 

3.  Friction  with  the  thumb  upon  the  extensors 
of  the  hand  and  fingers  with  repeated  strokings  of  the 
same  part. 

4.  Friction  with  the  thumb  of  the  other  hand 
upon  the  flexors  of  the  hand  and  fingers,  with  re- 
peated strokings  upon  the  same  part. 

5.  Friction  with  the  hand  upon  the  arm  proper. 

6.  Stroking  of  the  whole  arm,  as  described  in  1 
and  2. 

7.  Kneading  with  the  two  thumbs  of  both  hands 
upon  different  muscles,  special  attention  being  paid 


MASSAGE  25 

to  reach  the  extensors  and  flexors  in  the  forearm, 
the  biceps,  triceps,  deltoid,  supraspinous  and  in- 
fraspinatus. 

8.  Hacking  over  the  whole  arm. 

The  most  common  mistakes  in  treating  the  arm  are: 

1.  Too  tight  grasp  around  the  wrist  with  the 
supporting  hand. 

2.  The  arm  is -kept  too  rigid,  preventing  the  proper 
and  necessary  relaxation  of  the  muscles. 

3.  The  muscles  of  the  upper  part  of  the  arm 
and  shoulder  are  too  often  neglected. 

4.  Inefficient  kneading. 

III.  MASSAGE  OF  THE  CHEST 

Position. — The  patient  is  lying  flat  on  the  back, 
without  head-rest,  and  the  arms  placed  at  the  sides. 

1.  Stroking  with  both  hands,  one  on  each  side 
of  the  sternum.  The  manipulation  should  be  per- 
formed upward  and  inward,  making  a  somewhat 
circular  motion  (see  Fig.  2). 

2.  Friction  with  thumb  over  pectorales  major 
and  minor,  with  repeated  strokings.  Always  from 
the  origin  (sternum)  toward  the  insertion  (the  arm) . 

3.  Kneading  with  the  thumb  and  ringers  (pinch- 
ing) if  the  muscles  of  the  one  side  be  paralyzed. 

4.  Hacking  or  clapping  over  the  chest  may  also 
be  used,  according  to  circumstances.  Punctation 
in  circles  around  the  heart  has  also  been  recom- 
mended, but  if  used,  great  care  should  be  taken. 


26  MASSAGE 

As  a  rule,  all  percussions  applied  to  the  thorax 
should  be  used  with  discretion. 

In  massage  of  the  breast  place  the  hands  at  the 
outer  circumference  and  by  alternate  frictions  pro- 
ceed upward  to  the  nipple.  In  cases  of  caked 
breasts  it  is  often  necessary  to  use  frictions  with  the 
tips  of  the  fingers  over  hard  places  to  relieve  dis- 
tended ducts.  Always  finish  the  treatment  with  the 
so-called  "fulling"  consisting  of  gentle  pressure  from 
the  base  of  the  breast  upward  with  both  hands 
alternately.  Massage  with  camphorated  oil  is  a 
great  relief  in  over-distended  breasts.  The  operator 
should  always  be  careful  not  to  bruise  the  glands  in 
any  way,  as  tumors  are  liable  to  develop  in  after 
years  and  cause  no  end  of  trouble.  Massage  and 
exercise  are  the  only  means  by  which  the  bust  can 
be  properly  developed.  The  patient  should  be 
taught  how  to  breathe  properly  and  for  the  quick 
development  of  the  mammary  glands  use  in  the 
massage  as  above  described  the  following  prepara- 
tion, recommended  by  Dr.  W.  J.  Haynes: 

Lanoline -. 2  ounces 

Cocoa  Butter 2  ounces 

Oil  Cajegut 1  ounce 

Oil  Sassafras }/2  ounce 

Extract  Saw  Palmetto 2  ounces 

This  preparation  has  not  a  fine  odor,  but  pro- 
duces a  pleasant  sensation  in  the  skin.  It  is  a 
valuable  compound  wherever  we  wish  to  develop  a 
part,  but  should  not  be  used  on  the  face. 


MASSAGE 


27 


IV.  MASSAGE  OF  THE  BACK 

Position. — The  patient  is  lying  on  his  facej 
without  the  head-rest;  the  arms  should  be  kept 
at  the  sides. 

1.  Stroking  with  both  hands,  one  on  each  side 
of  the  spinal  column,  from  the  base  of  the  skull 


Fig.   15. — Pinching  on  the  Sides  so  as  to  act  on  Sympathetic 

Ganglia. 

down  to  the  sacrum.  If  on  a  large  person,  the 
operator  had  better  divide  the  back  into  three  parts, 
in  such  a  manner  as  to  first  work  next  to  the  spinal 
column,  then  over  the  center  of  the  back,  and  finally 
over  the  sides,  remembering  that  by  the  last  manipu- 


28 


MASSAGE 


lation  he  may  conveniently  reach  the  liver  or  spleen, 
if  desirable  in  certain  cases.  In  the  case  of  an  infant, 
and  especially  in  infantile  paralysis,  we  often  use 
in  the  stroking  only  the  index  and  the  middle 
fingers,  one  on  each  side  of  the  spinal  column. 

2.  Friction  with  the  hand  or  with  the  last  two 
phalanges  of  the  one  hand,  from  the  upper  part  of 
the  trapezius  down  to  the  glutei,  one  side  at  a  time. 

3.  Stroking  as  previously  described. 


\ 


Fig.  16. — Kneading  of  the  Back. 


4.  Kneading  with  the  two  thumbs,  one  on  each 
side  of  the  spine,  so  as  to  act  upon  the  spinal  nerves. 
The  hands  should  be  spread  over  the  back,  support- 
ing the  sides  if  possible  (see  Fig.  16). 

5.  Pinching  on  the  sides  so  as  to  act  upon  the 
sympathetic  ganglia  (see  Fig  15). 

6.  Hacking  with  one  hand  on  each  side  of  the 
spine,  up  and  down,  from  the  sacrum  to  the  neck. 


MASSAGE 


20 


7.  Clapping  on  both  sides,  lengthwise,  one  at  a 
time  (see  Fig  17). 

8.  Stroking  repeated;  performed  very  quickly  if 
we  wish  to  stimulate;  very  slowly  and  firmly  if  we 
wish  the  manipulation  to  have  a  soothing  effect. 


Fig.  17. — Clapping  on  Both  Sides. 


V.  MASSAGE  OF  THE  GLUTEI 

Position. — The  patient  is  standing  with  the  body 
bent  forward  and  supported  on  a  lounge  or  bed- 
stead.    The  operator  stands  behind  and  performs: 


3° 


MASSAGE 


i.  Stroking    with    both    hands    from    the    spine 
outward,  downward  (see  Fig.  18). 

2.  Friction  with  the  hand;  one  side  at  a  time. 

3.  Beating  in  circles,  one  side  at  a  time. 

If  the  patient  is  suffering  severe  pain  from  stand- 
ing the  manipulation  may  be  performed  while  he  is 


Fig.   18. — Stroking  of  the  Glutei. 

in  bed,  with  a  couple  of  pillows  placed  underneath 
his  abdomen  and  thighs. 

VI.  MASSAGE  OF  THE  ABDOMEN 

Position. — The  patient  is  lying  flat  on  his  back, 
generally  without  head-rest,  and  with  the  knees 
drawn  up,  so  as  to  relax  the  abdominal  muscles  (see 


MASSAGE  3 1 

Fig.  19).     It  is  most  convenient  for  the  operator  to 
sit  at  the  patient's  right  side. 

1.  Friction  with  the  tips  of  the  ringers  in  circles 
from  right  to  left  over  the  umbilical  region  of  the 
abdomen,  thereby  acting  upon  the  smaller  intestine. 
Begin  with  a  very  gentle  pressure,  gradually  increas- 
ing the  strength  of  the  manipulation  (see  Fig.  20). 

2.  Spread  the  right  hand  over  the  abdomen  so 
that  the  ball  of  the  hand  covers  part  of  the  ascending 
colon;  press  over  that  part  upward  to  the  transverse 


Fig.   19. — Position  in  Massage  of  the  Abdomen  and  the  Ventricle. 

colon;  then  stroke  with  the  radial  border  of  the  hand 
firmly  over  to  the  left  side.  Here  the  tips  of  the 
fingers  should  be  used  for  the  downward  pressure 
over  the  descending  colon.  The  manipulation  is 
repeated  in  circles  without  interruption  (see  Fig.  21). 

These  two  manipulations  are  schematically  il- 
lustrated in  Figs.  20  and  21,  and  the  operator  should 
teach  the  patient  how  to  perform  them  on  himself 
every  morning,  particularly  in  cases  of  constipation. 

A  cannon  ball  covered  with  leather  is  also  very 


32 


MASSAGE 


useful  in  manipulation  No.  2,  when  the  patient 
for  some  reason  is  obliged  to  do  it  himself.  They 
can  be  procured  from  Charles  Lentz  and  Sons, 
Philadelphia. 


Fig.  20. 


3.  Kneading  with  the  heel  of  the  hand  over  the 
whole  abdomen,  going  carefully  at  first  and  avoiding 
any  sore  places.  Fecal  lumps  are  often  found  and 
they  should  be  gently  and  gradually  broken  up. 


MASSAGE 


33 


Near  the  sigmoid  flexure  we  can  sometimes  ac- 
complish more  by  substituting  this  manipulation 
for  that  of  the  friction  with  the  tips  of  the  fingers. 
The  reason  for  that  is  that  we  can  reach  in  deeper  and 


Fig.  21. 


our  efforts  become  more  localized.  The  same  refers 
to  the  breaking  up  of  adhesions  around  the  appendix 
and  the  ovaries. 

This    manipulation   will    sometimes   produce    an 


34  MASSAGE ' 

unpleasant  sensation  at  first,  which  is  frequently 
caused  by  the  patient  not  breathing  properly. 
Talk  to  him  so  as  to  make  him  forget  that  he  is 
being  treated.  Some  operators  place  one  hand  as  a 
support  under  the  patient's  back,  and  it  is  a  very 
good  idea,  as  the  manipulation  feels  more  comfortable 
and  we  have  a  better  and  more  fixed  control  over 
the  abdominal  viscera. 

In  the  case  of  diarrhea,  stomach-pit  shaking 
is  very  effective.  Begin  at  the  epigastrium  and 
shake  from  side  to  side  covering  the  whole  ab- 
domen (Fig.  34).  Best  given  in  half -lying  position. 
— {Editor) 

4.  Vibrations  over  the  descending  colon. 

5.  Turn  the  patient  on  his  face  and  perform 
firm  beating  of  the  sacrum  in  circles  so  as  to  act 
upon  the  rectum. 

Massage  of  the  abdomen  must  never  be  applied 
soon  after  a  meal  is  partaken  of.  It  is  well  to  tell 
the  patient  to  evacuate  the  bladder  before  beginning 
the  treatment. 

In  chronic  cases  of  constipation  it  is  a  good  plan 
to  have  the  patient  take  an  enema,  so  as  to  clean 
out  the  sacculated  colon  before  starting  the  first 
treatment.  The  indiscriminate  and  continued  use 
of  injections  will  produce  a  relaxed  condition  of  the 
bowel,  while  on  the  contrary  massage  will  strengthen 
and  stimulate  to  normal  activity  its  various 
membranes. 


MASSAGE  35 

VII.  MASSAGE  OF  THE  LIVER 

Position. — The  patient  is  lying  half  way  turned 
over  on  his  left  side.  The  operator  sits  at  his  right 
side. 

i.  Friction  with  the  palm  of  the  hand  in  large 
circles  covering  gradually  the  entire  organ. 

2.  Kneading  with  the  heel  of  the  hand. 

3.  Clapping  over  the  entire  organ,  firmly  over 
the  right  hypochondriac  region,  more  gently  over 
the  epigastrium  and  left  hypochondrium. 

4.  Palmar  vibration  over  the  different  lobes. 

5.  Digital  vibration,  working  the  separated  and 
bent  ringers  gradually  under  the  curve  of  the  ribs 
and  costal  cartilages. 

Deep  respiratory  exercises  are  very  important 
in  connection  with  massage  of  the  liver. 

VIII.  MASSAGE  OF  THE  SPLEEN 

Position. — The  patient  should,  of  course,  lie  on 
his  right  side.  This  treatment  is  performed  in  a 
similar  way  as  massage  of  the  liver. 

IX.  MASSAGE  OF  THE  STOMACH 

Several  methods  have  been  proposed  to  reach 
the  ventricle  by  massage.  They  are  all  more  or 
less  dangerous,  and  we  mention  one  of  them  only, 
for  the  completeness  of  the  system. 

Position. — The  patient  is  lying  flat  on  his  back, 
as  described  on  page  31,  Fig.  19. 


36 


MASSAGE 


i.  The  operator  sits  at  his  side,  and  quietly 
placing  his  right  hand,  with  abducted  thumb, 
about  two  inches  below  the  ribs  of  the  left  side, 
he  performs  strokings  and  frictions  of  the  organ, 
from  left  to  right.  Jn  dilatation  of  stomach  use  same 
grip,  pressing  upward  under  strong  vibration. 
— {Editor)  Friction  with  the  tips  of  the  ringers  is 
the  most  convenient  form  to  use. 


Fig.  22. — Stroking    of    the    Forehead. 

2.  Kneading  with  the  two  thumbs  may  also  be 
used,  but  the  operator  should  always  remember 
that  he  has  to  deal  with  very  sensitive  parts,  con- 
sequently his  pressure  should  be  moderate. 

3.  Vibration  with  the  tips  of  the  fingers. 

X.  MASSAGE  OF  THE  HEAD 

Position. — The  patient  is  sitting,  comfortably 
supported. 


MASSAGE  37 

i.  Stroking. — Beginning  with  the  back  of  the 
head,  keeping  the  left  hand  firmly  on  the  forehead, 
and  with  the  right  in  a  V-shape,  stroke  downward. 
In  stroking  the  forehead  place  the  thumbs  between 
the  eyebrows  and  stroke  firmly  over  the  temples  to 
the  ears,  both  thumbs  working  together,  so  as  to  act 
upon  the  supraorbital  nerve  (see  Fig.  22). 

2.  Friction  with  the  one  hand,  the  other  support- 
ing, on  the  diagonally  opposite  part  of  the  head. 

I  have  always  found  it  best  and  most  expedient 
to  divide  the  head  into  four  divisions  for  applying 
this  manipulation,  always  beginning  with  the  back 
part  of  the  right  side. 

3.  Friction  with  the  tips  of  the  fingers  pressing 
firmly  so  as  to  move  the  scalp  and  to  prevent  break- 
ing off  the  brittle  or  weakened  hairs.  This  manipu- 
lation is  particularly  valuable  when  we  work  in  a 
hair  tonic.  By  working  the  scalp  we  draw  the  blood 
to  the  hair -roots  (see  Fig  23). 

4.  Hacking  is  used  with  both  hands  striking 
together,  making  circles  over  the  head,  beginning 
on  the  top  and  moving  backward,  downward,  and 
forward  to  the  starting  point. 

For  increasing  the  hair  growth  the  author  has 
never  found  anything  to  equal  the  following  treat- 
ment. Shampoo  the  head  freely  with  a  good,  pure 
tar  soap  and  let  the  lather  remain  for  two  hours, 
then  wash  it  off  with  warm  water,  adding  a  little  of 
some  good  tonic.  Now  massage  the  scalp  thoroughly 
with  crude  petroleum  and  allow  that  to  stay  on 


38 


MASSAGE 


over  night.  Of  course  the  patient  must  wear  a 
night-cap  or  in  some  other  way  protect  the  pillow- 
slip. 

The  author  has  experimented  lately  with  the  new 
oxygenated  petroleum  product, "  Petrogen"  (Wyeth) , 


Fig.   23. — Friction  with  Tips  of  the  Fingers. 


as  a  base  for  a  hair  tonic  and  the  results  have  been 
so  exceptionally  good  that  he  begs  to  call  the  reader's 
special  attention  to  it. 


MASSAGE  39 


XI.  MASSAGE  OF  THE  FACE 

Position. — The  patient  is  lying  or  sitting  with 
the  head  comfortably  supported.  Tell  him  to 
relax  the  muscles  of  the  head  and  neck. 

i.  Stroking  with  the  two  thumbs  over  the  fore- 
head, starting  near  by  the  eyebrows  gradually  in 
succession  working  up  to  the  hair-roots  as  in  Fig.  22. 

2.  Friction  with  the  tips  of  the  fingers  in  small 
circles,  the  other  hand  being  used  to  stretch  the 
part  worked  upon;  for  this  manipulation  divide 
the  forehead  in  two  sections  vertically.  This  is 
principally  applied  with  the  object  of  overcoming 
wrinkles  of  the  forehead. 

3.  Repeated  stroking  as  in  No.  1,  the  operator 
being  careful  to  tightly  grasp  the  temples,  so  as  to 
make  the  patient  feel  that  the  head  is  properly 
supported. 

4.  Stroking  with  the  tips  of  the  ringers  over  and 
below  the  eyes  from  the  nose  outward  to  the  temples, 
both  sides  at  a  time. 

5.  Friction  with  the  tips  of  the  fingers  over  the 
same  part  with  special  attention  to  the  outer  corner 
of  the  eye  and  below  it,  where  we  generally  find  the 
so-called  "crow  feet."  Stretch  the  part  with  the 
thumb  and  fingers  of  one  hand,  and  perform  the 
friction  with  the  tips  of  the  fingers  of  the  other  hand. 

6.  Repeated  strokings  as  in  No.  4. 

7.  Stroking  with  the  two  index-fingers  over  the 
nose  from  the  eyebrows  downward  and   outward. 


40  MASSAGE 

Raise  the  hands  up  high  and  hold  them  so  during  the 
manipulation  from  start  to  finish.  Tn  other  words, 
the  heel  of  the  hand  should  be  on  a  level  with  the  tip 
of  the  finger. 

8.  Stroking  with  both  hands  one  on  each  side  of 
the  face  from  the  extreme  lower  part  of  the  inferior 
maxillary  region  well  up  to  the  temple.  We  stroke 
upward  because  the  face  frequently  presents  a 
drawn  and  pulled-down  appearance;  particularly  so 
after  a  prolonged  illness  or  a  siege  of  nervous  worry 
ortension. 

9.  Friction  and  kneading  of  the  cheeks,  picking  up 
the  muscles  as  much  as  possible,  always  remember- 
ing that  the  orbicularis  oris  is  the  insertion  of  most  all 
the  principal  facial  muscles. 

10.  Repeated  strokings  as  in  No.  8,  only  the  pa- 
tient is  told  to  inflate  his  cheeks  and  to  retain  the  air, 
breathing  freely  through  his  nose. 

n.  Stroking  with  the  fingers  around  the  lips  and 
chin. 

12.  Frictions  with  the  tips  of  the  fingers  over  the 
same  part  of  kneading  if  our  object  is  to  remove 
superfluous  fat.  In  the  latter  case  never  use  any 
fatty  ointment,  but  instead  some  benzoin  prepara- 
tion that  will  help  to  contract  the  tissues. 

13.  Strokings  repeated,  as  described  in  No.  n. 
In  treating  wrinkles  the  operator  should  remember 

that  they  are  not,  as  a  rule,  caused  by  some  trouble 
in  the  skin  itself,  but  mostly  always  by  a  relaxed  or 
weakened  condition  of  the  underlying  muscular  tis- 


MASSAGE  41 

sues;  consequently  our  work  must  not  be  superficial 
but  deep,  care  being  taken,  of  course,  not  to  bruise  the 
patient.  By  stimulating  the  circulation  to  this 
particular  part,  we  bring  in  increased  nourishment  to 
the  relaxed  and  weakened  tissues.  It  is  really 
wonderful  what  can  be  done  in  the  way  of  improving 
the  facial  expression  by  scientific  massage,  but  like 
other  parts  of  this  valuable  therapeutic,  it  has  been 
horribly  abused.  Steaming  the  face  is  frequently 
practised  but  it  is  not  to  be  recommended  inasmuch 
as  it  frequently  causes  the  patient  to  contract  a 
severe  cold.  Facial  paralysis  and  "tic  douloureux" 
have  been  traced  to  steaming  of  the  face.  A  massage 
operator  who  can  not,  by  his  manipulations,  bring 
enough  blood  to  the  relaxed  parts  should  not  treat 
a  face!  Scars  are  treated  by  stretching  the  part  and 
working  with  the  tips  of  the  fingers  in  circles  across 
the  scar- tissue,  finishing  with  strokings.  Never  use  an 
ointment  for  facial  massage  that  contains  vaselin  or 
lanolin.  They  are  both  apt  to  produce  hair  growth, 
particularly  the  former.  There  are  so  many  inferior 
preparations  on  the  market,  that  the  author  feels 
prompted  to  here  give  a  recipe  for  a  very  good  facial 
skin  food  known,  and  in  the  many  years  he  has 
recommended  it,  he  has  never  heard  anything  but  the 
very  best  results  from  it. 

Oil  of  Sweet  Almonds 2  ounces 

Spermaceti M  ounce 

White  Wax M  ounce 

Orange  fl.  water K  ounce 


42  MASSAGE 

It  will  be  noticed  that  there  are  no  mineral 
fats  amongst  the  ingredients.  Care  should  be 
taken  to  see  that  the  genuine  spermaceti  and  wax 
be  used,  as  both  these  preparations  are  "made" 
from  coal  oil  and  we  should  not  be  willing  to  risk 


Fig.  24. — Massage  of  the  Face. 

causing  a  hair  growth  on  the  face.  If  we  wish  to 
make  the  eyebrows  thicker  and  wider  we  can  do  so. 
with  the  aid  of  coal  oil  preparations,  but  it  must  be 
done  by  a  trained  person.  Mr.  C.  Keeny,  1601 
Arch  Street,  Philadelphia,  prepares  the  above- 
mentioned  " Skin-food"  and  it  can  be  obtained 
from  him  at  any  time. 

In  cases  of  facial  paralysis  it  becomes  necessary 
to  work  somewhat  differently  than  previously  de- 
scribed.     Cover   the   antiseptically   cleaned  index- 


MASSAGE  43 

linger  with  a  rubber  tip  or  a  silk  handkerchief,  insert  it 
in  the  mouth  and  with  the  thumb  stroke  the  muscles 
in  the  superior  and  inferior  maxillary  regions  (see 
Fig.  24).  The  index  acts  as  a  good  and  easily  regu- 
lated support.  Friction  and  kneading  are  given 
in  a  similar  way.  In  applying  vibrations  to  the 
facial  nerves  and  muscles,  the  author  has  used  with 
the  greatest  satisfaction  the  mechanical  vibrator 
made  by  the  Vibratile  Company  of  New  York  City. 
There  are  now  many  different  vibrators  on  the 
market  and  the  masseur  should  have  at  least  one 
of  them.  Most  of  them  are  run  by  power  obtained 
from  the  electric  street  current.  Unfortunately 
this  form  of  massage  has  been  taken  up  by  the  bar- 
bers, many  of  whom  use  it  without  thought  and 
discretion. 

XII.  MASSAGE  OF  THE  EYE 

Position.- — The  patient  sits  with  the  head  leaning 
backward,  the  operator  standing  at  his  side. 

1.  The  index-finger  is  placed  on  his  eyebrow, 
the  middle  finger  grasping  the  eyelid,  which  is  pressed, 
with  either  a  radial  or  circular  motion,  against  the 
eye.  Be  very  careful  not  to  use  too  much  strength, 
and  perform  the  movement  as  quickly  as  possible 
(see  Fig.   25). 

By  placing  the  index  on  the  eyebrow  we  take  the 
weight  of  the  heavy  hand  off  the  tender  organ.  The 
lid  really  performs  the  massage  by  pressure  generated 
through  the  ringer. 


44 


MASSAGE 


2.  Vibrations  with  the  fingers  (see  Fig.  37). 
While  it  is  understood  that  the  operator's  hands 
should  at  all  times  be  scrupulously  clean,  it  becomes 
necessary  to  always  use  a  mild  antiseptic  before 
treating  the  eyes. 

XIII.  MASSAGE  OF  THE  THROAT 

Position. — The  patient  is  sitting,  in  a  somewhat 
reclining  position. 


i 


Fig.  25. — Massage  of  the  Eye. 

Stroke  with  two  fingers  on  one  side  and  the  thumb 
on  the  other  side  of  the  trachea.  Finish  with 
similar  stroking  in  connection  with  a  slight  shaking. 

For  the  position  of  the  hands  in  the  vibration  of 
the  trachea  and  its  surrounding  tissues  see  Fig.  36, 
on  page  58. 


MASSAGE 
XIV.  MASSAGE  OF  THE  NECK 


45 


Position. — The  patient  faces  the  masseur  (see  Fig. 
27)  with  the  head  thrown  back,  so  as  to  expose  the 
neck.     The  operator  places  his  hands  at  the  lobes 


Fig.  26. — Avoid  Pressure  on  the  Jugular  Vein. 

of  the  ears  and  performs  a  stroking  downward  to  the 
shoulder.  The  patient  should  be  told  to  breathe 
freely  and  easily.  This  method  (originated  by  Dr. 
Gerst)  is  used  principally  to  increase  the  circulation 
in  the  veins  of  the  neck. 


46 


MASSAGE 


Another  method  of  massage  of  the  neck  has  been 
recommended  by  Hoeffinger.  The  patient  is  sitting 
with  the  head  erect.  The  operator  stands  behind 
and    places    his    hands    underneath    the    patient's 


Fig.  27. — Massage   of   the    Neck,    Gerst's    Method. 


ears.  The  stroking  is  performed  downward  toward 
the  shoulder,  the  hand  covering  the  principal  part 
of  the  trapezius  (see  Fig.  28). 

I  have  often  found  frictions,  kneadings  and  hack- 
ing of  the  neck   (see   Figs.   29,  30  and  31)   of  the 


MASSAGE 


47 


greatest  benefit,  especially  in  cases  of  congestions 
and  headaches,   as  recommended  by  Reibmayer. 

XV.  MASSAGE  OF  THE  NOSE 

Position. — The  patient  reclining. 

The    forefinger    of    each    hand    of    the    operator 


Fig.  28.— Massage  of  the  Neck,  Hoeffinger's  Method. 

is  applied,  with  mild  pressure,  to  each  side  of  the 
nose,  of  the  patient.  A  stroking  downward  is 
slowly  and  carefully  performed. 


48 


MASSAGE 


Fig.  29 .— Kneadings  of  the  Neck. 


MASSAGE 


49 


In  removing  scars  on  or  near  the  nose  stretch 
the  part  and  work  crosswise,  as  described  under 
massage  of  the  face. 


Fig.  30. 


XVI.  MASSAGE  OF  THE  OVARIES 

Position. — The  patient  should  be  flat  on  her 
back  without  head-rest  and  the  knees  drawn  up 
so  as  to  completely  relax  the  abdomen. 

1.  Stroking    with    both    hands.     The    operator 


5° 


MASSAGE 


stands  with  her  back  to  the  patient  placing  her 
hands  near  the  crests  of  the  ilium,  stroke  simul- 
taneously with  both  hands  downward  and  inward 
to  the  center. 


Fig.  31. 


2.  Friction  with  the  tips  of  the  fingers.  This 
manipulation  is  used  particularly  when  we  wish  to 
break  down  adhesions. 

The  patient  should  be  instructed  to  breathe 
deeply.     Massage   of   the   ovaries  is  freely  recom- 


MASSAGE  51 

mended  by  European  gynecologists  and  we  have 
many  remarkable  reports  of  complicated  cases  suc- 
cessfully treated.  Gynecologic  massage  should  not 
be  practised  by  a  non-medical  man. — [Editor.] 

XVII.  MASSAGE  OF  THE  UTERUS 

Position. — The  same  as  for  massage  of  the 
abdomen  (see  Fig.  19,  page  31). 

The  external  method  is  merely  a  modification 
of  the  massage  of  the  abdomen.  The  patient 
must  be  in  a  half  lying  position,  with  the  knees 
flexed  in  order  to  relax  the  abdominal  muscles. 
Begin  with  the  circular  manipulations,  from  right 
to  left,  following  with  stroking  and  friction  over  the 
lower  part  of  the  abdomen. 

It  is  generally  used  for  atony  of  the  uterine 
organs,  and  must  always  be  succeeded  by  percussion 
or  beating  of  the  lower  part  of  the  back.  The 
Swedish  movements  are  a  valuable  auxiliary,  con- 
trolling as  they  do,  the  circulation  in  the  abdomen 
and  the  lower  extremities.  The  massage  increases 
the  current  in  the  blood-vessels  and  the  lymphatics, 
the  resorption  is  restored,  and  the  muscular  organs 
in  the  smaller  pelvis  are  strengthened. 

Special  manipulation  of  the  intestines  relieve  the 
bowels,  which  in  cases  of  uterine  affections  must 
be  of  great  importance. 

2.  A  second  method  is  rather  difficult  to  per- 
form, as  one  or  two  fingers  must  be  inserted  in  the 
vagina  or  the  rectum,  against  which  we  work  from 


52  MASSAGE 

the  outside.  It  should  be  performed  only  by  a 
person  who  has  a  thorough  knowledge  of  the  parts; 
in  fact  it  belongs  to  the  practice  of  the  gynecologist 
alone.  Dr.  Homer  C.  Bloom,  of  Philadelphia,  has 
written  a  valuable  little  pamphlet  on  "Pelvic 
Massage."  He  describes  the  treatment  and  fur- 
nishes reports  of  some  few  cases.  There  is  one 
part  which  is  particularly  interesting  to  every 
scientific  masseur.  Dr.  Bloom,  after  summarizing 
the  results,  says:  "It  has  been  noticed  that,  in 
a  great  number  of  these  cases,  there  was  a  con- 
comitant condition  of  hemorrhoids,  which  were 
relieved  in  every  instance. " 

Dr.  Norstrom,  in  Paris,  recommends  in  massage  of 
the  uterus: 

i.  Graduate  the  pressure  of  the  uterine  body  after 
you  have  seized  it. 

2.  In  order  to  get  a  good  hold,  push  down  during 
expiration;  maintain  the  distance  gained  during  in- 
spiration and  start  again  during  the  next  expiration. 

3.  Be  careful  not  to  increase  by  any  sudden  move- 
ments, the  painful  impression  experienced  by  the 
patient  when  the  uterus  is  first  taken  hold  of;  wait 
a  moment  before  beginning  pressure.  The  pressure 
sometimes  produces  reflex  pains  in  various  parts  of 
the  body. 

4.  Devote  all  your  attention  to  supporting  the 
uterus.  This  is  easy  when  it  is  large  and  soft;  very 
difficult  when  it  is  small  and  hard;  it  is  then  that  it 
moves  with  great  facility  to  one  side  or  the  other. 


MASSAGE  53 

Any  one  specially  interested  in  uterine  massage 
will  find  a  great  deal  of  valuable  information  in  a 
book  published  by  Dr.  Rob.  Ziegenspeck,  of 
Munich,  and  translated  into  English  by  Dr.  F.  H. 
Westerschulte,  of  Chicago.  In  this  book  Major 
Thure  Brandt's  methods  are  carefully  analyzed  and 
illustrated. 

XIII.  MASSAGE  OF  THE  PROSTATE  GLAND 

Two  methods  are  used,  one  external  and  one  in- 
ternal. In  the  first  the  patient  is  placed  flat  on  his 
back,  holding  himself,  the  reproductive  organs 
stretched  up  on  the  abdomen.  The  perineum  is 
massaged  with  strokings  and  frictions. 

In  the  other  method  the  operator  inserts  his 
covered  middle  or  if  necessary  index-  and  middle- 
finger,  with  some  lubricant  on  the  finger,  cold  cream 
or  pure  fresh  lard,  in  the  patient's  rectum;  and  fixing 
the  gland  he  supports  it  from  the  inside  while  the 
thumb  and  the  fingers  of  the  "other  hand  perform 
the  manipulations.  The  bladder  should  always  be 
evacuated  before  beginning  the  treatment. 

Some  forms  of  vibrations  have  proved  very  use- 
ful, particularly  when  applied  through  the  rectum 
internally. 


PRESSING  AND  SHAKING 
(VIBRATIONS) 

Closely  connected  with  the  massage  proper  are  the 
oscillatory  movements, — which  we  call  vibrations, — 
used  principally  upon  the  extremities  and  over  some 
of  the  internal  organs. 

We  have  two  principal  forms  of  vibrations — viz., 
digital,  with  one  or  more  fingers;  palmar,  with  the 
palm  of  the  hand.  In  digital  vibration  the  operator 
uses  his  fingers  in  vertical  motion  over  a  nerve  or 
separate  organ,  no  flexion  or  extension  of  the  hand 
being  allowed,  as  too  heavy  pressure  will  then  be 
made.  "The  straining  of  the  muscles  in  the  opera- 
tor's arm  ought  to  be  so  slight  as  to  be  scarcely  per- 
ceptible to  any  one  who  has  his  hand  over  them." 

In  Fig.  32  we  have  represented  a  digital  vibration 
of  the  forearm.  Vibration  of  the  whole  arm  is  given 
in  the  following  manner:  The  operator  grasps  the 
hand  and  shoulder,  keeping  the  arm  in  an  extended 
position,  and  shakes  as  quickly  as  possible.  The 
movement  may  also  be  performed  by  two  operators. 

In  vibration  of  the  leg  the  operator  grasps  the 
foot  with  one  hand  and  the  thigh,  as  high  as  possible, 
with  the  other,  he  raises  the  limb  up  and  shakes 
it  quickly. 

In   Fig.   33   we   have   demonstrated   the   palmar 

54 


MASSAGE 


55 


Fig.  32. — Digital   Vibration. 


Fig.  33. — Vibration  of  the  Liver. 


56 


MASSAGE 


vibration  of  the  liver.  Change  the  position  of  the 
hand  several  times,  so  as  to  act  upon  the  different 
parts  of  the  organ.  In  vibration  of  the  spleen  the 
hand  is  placed  in  a  similar  position. 


Fig.  34. — Vibration  over  the  Solar  Plexus. 

Vibration  at  the  pit  of  the  stomach  is  clearly  dem- 
onstrated in  Fig.  34.  Place  the  finger-tips  about 
two  inches  below  the  ensiform  cartilage  and  perform 
the  shaking  backward  and  upward.  The  patient 
may  also  stand  with  his  hands  clasped  at  the  back 


MASSAGE 


57 


of  his  head.  This  form  of  vibration  is  exceedingly 
useful  in  certain  affections  of  the  stomach.  It 
also  acts  strongly  upon  the  solar  plexus. 

Pressing  and  shaking  of  the  bladder.     The  patient 
is  lying  flat  on  his  back  with  knees  drawn  up  so  as  to 


Fig.  35. — Vibration  over  the  Bladder. 

relax  the  abdominal  muscles.  The  operator  stands 
at  his  side,  as  in  Fig.  35,  and  with  his  ringers  he  per- 
forms a  gentle  pressure  and  quick  vibrations.  Used 
in  affections  of  the  bladder  and  the  prostate  gland 
with  modifications,  also  in  uterine  and  rectal  troubles. 


5« 


MASSAGE 


Vibration  of  the  larynx  is  shown  in  Fig.  36.  The 
thumb  is  placed  on  one  side  of  the  thyroid  cartilage 
and  the  fingers  on  the  other.  It  should  be  per- 
formed gently  at  first  until  the  patient  becomes 
used  to  it. 

In  Fig.  37  we  show  the  vibration  of  the  eyes.  The 
patient  is  sitting  with  the  back  supported.     The 


(  m  " 

Fig.  36. — Vibration  of  the  Larynx. 

operator  stands  behind  and  places  two  fingers  over 
each  eye.  The  lids  should  not  move  up  and  down, 
but  be  kept  steady,  as  the  vibration  is  generated 
through  them. 

Vibrations  are  also  used  over  the  pharynx,  the 
thorax  (one  hand  on  each  side  generally)  the  head, 
the  heart  and  different  parts  of  the  abdomen.     The 


MASSAGE 


59 


author  frequently  uses  the  vibration  of  the  de- 
scending colon  and  over  the  sigmoid  flexure  with  the 
most  excellent  results. 

Pressing    and    shaking    have    a    stimulating   and 
strengthening  effect  upon  the  nerves;  they  also  act 


Fig.  37. — Vibration    of   the    Eyes. 

strongly  upon  the  circulation  of  the  venous  blood- 
vessels and  the  lymphatics. 

Kellgren's  "Technic  of  Manual  Treatment" 
is  an  interesting  book  on  the  subject  of  vibrations 
in  general  and  their  therapeutic  indications. 


DETAILS  OF  TREATMENT 

The  strength  of  the  various  manipulations  is  a 
principal  point  in  the  massage  treatment,  and  the 
"self-made"  masseur  will  often  unnecessarily  bruise 
his  patients.  As  a  rule,  begin  with  a  moderate 
pressure,  ascertaining  from  the  patient  his  sensation. 
A  new  operator  has  often  the  fault  of  using  too  much 
pressure. 

To  avoid  abrasions  most  all  Scandinavian  operators 
use  some  kind  of  oleaginous  substance.  Among  prep- 
arations recommended  we  have  used  with  advan- 
tage: White  vaselin,  glycerin,  lanolin,  lard,  olive  oil, 
arnica  oil  (in  sprains  or  distortions),  belladonna  oint- 
ment (in  neuritis), — the  two  latter  only  when  recom- 
mended by  physicians.  See  Neuritis,  page  135,  for 
additional  medication.  Any  of  these  preparations 
may  be  used,  but  I  would  caution  operators  against 
using  too  much  glycerin,  as  it  tends  to  irritate  the 
skin.  In  America  cocoanut-oil  or  cocoa-butter  has 
been  freely  used. — Pure  cold  cream  is  one  of  the  best 
lubricants  and  almost  always  at  hand  in  every  home. 
White  vaselin,  on  the  contrary,  becomes  after  a  few 
massage  strokes  very  sticky;  lard  does  not  keep  well, 
but  is  good  when  fresh;  melted  cocoa-butter  answers 
the  purpose  also. — [Editor.] 

Some  physicians   and   patients    object    to    using 

60 


MASSAGE  6 1 

grease  of  any  kind.  It  is  not  my  intention  to  advise 
operators  to  use  large  quantities  of  fat,  but  just 
enough  to  make  the  manipulations  smoothly.  On 
very  hairy  persons  it  is  absolutely  necessary  to  use 
some  kind  of  grease. 

All  grease  must  be  well  rubbed  off  the  skin  before 
leaving  the  patient.  The  operator  should  wash 
his  hands  before  and  after  every  treatment;  if  nec- 
essary, use  some  antiseptic. 

Every  part  should  be  well  covered  after  masseeing 

it. 

MASSAGE  MUST  ALWAYS  BE  APPLIED  ON  THE 
NUDE  SKIN 

The  masseur  who  works  outside  the  clothes, 
when  acting  upon  special  parts  of  the  body,  "  works 
in  the  dark,"  tires  his  ringers,  and  loses  a  principal 
feature  in  the  application — the  feeling,  which  is  so 
extremely  necessary  in  a  careful  masseur.  Some 
authors  claim  that  working  outside  the  clothes  will 
save  the  patient's  skin;  but  could  anything  be  more 
pleasant  and  agreeable  than  a  soft  hand? 

CONTRAINDICATIONS  FOR  MASSAGE 

In  several  affections  massage  is  most  certainly 
contraindicated ;  and  in  many  the  treatment  must 
be  performed  very  carefully. 

The  first  important  requisite  is  that  the  skin  is  not 
severely  abraded.  Consequently,  massage  is  not 
to  be  used  in — 


62  MASSAGE 

i.  Skin  affections:  Wounds,  burns,  erysipelas, 
eczema,  acne,  and  specific  eruptions. 

2.  Certain  Affections  in  the  Blood-vessels  or  Lym- 
phatics.— This  must  be  especially  remembered  in 
elderly  persons,  whose  vessels  are,  as  a  rule,  very 
sensitive  to  mechanical  pressure. 

3.  In  tumors  and  purulent  inflammations,  in  which 
we  run  the  risk  of  transferring  the  virus  to  other 
healthy  tissues. 

4.  In  all  acute  affections  of  the  bone-tissue. 

5.  In  severe  constitutional  or  local  diseases,  where 
complete  rest  is  necessary.  (When  convalescent, 
massage,  is,  on  the  contrary,  in  many  cases,  one  of 
the  best  tonics.) 

6.  Pregnancy. — As  a  rule,  avoid  massage  during 
pregnancy,  and  especially  massage  of  the  abdomen. 

j.  All  affections  in  which  the  pressure  is  liable  to 
cause  a  hemorrhage. 

During  menstruation  it  is  best  to  discontinue 
general  massage,  and  under  no  circumstances  should 
the  abdomen  be  treated  unless  so  ordered  by  the 
attending  physician.  Such  prescriptions  will  some- 
times be  issued  in  cases  of  a  retarded  or  too  scanty 
flow. 


SWEDISH  MOVEMENTS 

The  Swedish  Movements  are  a  series  of  systematic 
exercises  therapeutically  applied  to  the  human  body. 

"Every  exercise  the  direction  and  the  duration  of 
which  are  fixed  is  a  movement" 

That  is  the  definition  of  a  movement  given  to  us 
by  the  Swede,  P.  H.  Ling,  who  lived  and  worked  in 
the  early  part  of  the  last  century.  He  erected  the 
first  system  of  scientific  movements,  as  before  his 
time  no  approach  had  been  made  to  a  method  of 
designating  and  classifying  the  positions  and  various 
movements  of  the  body  for  the  purposes  contem- 
plated in  the  Movement  Cure. 

In  every  science  terminology  is  necessary;  so  even 
in  this.  Ling  gave  every  movement  a  complicated 
or  double  name,  the  first  part  of  which  indicated  the 
position  which  the  patient  must  assume,  the  second 
part  telling  the  nature  of  the  movement  itself;  for 
instance,  sitting,  rotation  of  the  arms. 

Thus  it  is  left  to  us  to  first  analyze  the  positions 
and  afterward  the  movements. 

POSITIONS 

Movements  may  be  given  or  performed  in  many 
different  positions  of  the  body.     It  is  necessary  to 

63 


64  SWEDISH  MOVEMENTS 

have  a  commencing,  intermediate  and  terminating 
position.  Ling  said  that  to  render  any  movement 
definite  and  exact,  a  point  of  departure,  a  point  of 
termination,  and  the  line  through  which  the  body 
or  any  of  its  parts  must  pass,  are  to  be  clearly  deter- 
mined, as  well  as  the  rhythm  of  the  action  itself. 

There  are  in  Ling's  system  five  principal  or  funda- 
mental positions — viz. : 

i.  STANDING, 

2.  SITTING, 

3.  LYING, 

4.  KNEELING, 

5.  SUSPENDING  OR  HANGING. 
Standing. — In  this  position,  the  legs,  trunk,  and 

head  are  erect.  The  heels  should  be  together  and 
the  feet  should  form  right  angles.  The  arms  should 
be  kept  at  sides  (see  Fig.  38). 

Sitting. — In  this  position  the  buttocks  and  the 
posterior  part  of  the  thigh  rest  against  the  chair  or 
sofa.  The  legs,  close  together,  form  right  angles 
with  the  thighs.  The  trunk  and  head  should  be 
erect  (see  Fig.  39). 

Kneeling. — The  body  rests  upon  the  knees  and 
the  anterior  part  of  the  legs.  The  feet  should  be 
kept  outside  of  the  supporting  part,  as  demonstrated 
in  Fig.  40. 

Lying. — In  this  position,  the  patient's  body  rests 
against  the  sofa  or  bed  with  the  head,  the  back 
and  the  legs  (see  Fig.  41). 


SWEDISH   MOVEMENTS 


65 


Suspending. — In  this  position  the  patient  is  to 
grasp  a  horizontal  bar  that  is  elevated  so  that  the 
feet  do  not  touch  the  floor.     There  should  be  the 


Fig.    38. — Standing 
Position. 


Fig.    3Q. — Sitting 
Position. 


Fig.    40. — Kneeling 
Position. 


Fig.  41. — Lying   Position. 

same  distance  between  the  hands  on  the  bar  as 
between  the  shoulders  (see  Fig.  42).  The  position 
is  very  tiresome,  as  it,  to  a  certain  extent  prevents 


66 


SWEDISH   MOVEMENTS 


respiration  and  circulation,  on  account  of  the  exten- 
sion of  the  thorax.  It  should  be  used  with  great 
care;  and  if  the  patient  is  weak,  support  his  sides 
until  he  becomes  accustomed  to  it. 


Fig.  42. — Suspending  Position. 


From  each  one  of  these  principal  positions  Ling 
formed  many  derivatives  or  subdivisions  of  positions. 

We  only  mention  the  most  important,  and  the 
illustrations  will  enable  the  reader  to  fully  under- 
stand them. 


SWEDISH   MOVEMENTS 


67 


DERIVATIVE  POSITIONS  FROM  THE  STANDING 
POSITION 

1.  With  the  Lower  Extremities. 


Fig.  43.— Flex-     Fig.  44.— Little     Fig.  45.— Walk- 
Standing.  Knee-bend.  Standing. 


Fig.  46. — Side-       Fig.  47. — Side- 
Standing.  Flex-Standing. 


Fig.  48. — Balance- 
Standing. 


68 


SWEDISH  MOVEMENTS 


pIG    4Q> — Fall-Out-Standing. 


2.  With  the  Upper  Extremities. 


pIG    50__Bent-         Fig.  51  .—Before  Bent- 
Standing.  Standing. 


SWEDISH  MOVEMENTS 


69 


Fig.  52. 


Fig.  53-— Talk-     Fig.  54.— Arm  Stretched 
Standing.  Standing. 


Fig.  5  5 . — Wing-Standing. 


Fig.  56. — Think-Standing. 


70 


SWEDISH  MOVEMENTS 


Fig.  57. — Resist-Standing,  or 
Arm-lean  Standing. 


Pig.  58. — Rest- 
Standing. 


Fig.  59. — Yard-Standing. 


SWEDISH  MOVEMENTS 
3.  With  the  Trunk. 


71 


Fig.  60. — Curve-  Fig.    61. — Turn-     Fig.  62. — Stoop-Curve- 

Standing.  .  Standing.  Standing. 


DERIVATIVE  POSITIONS  FROM  THE  SITTING 
POSITION 

1.  With  the  Lower  Extremities. 


Fig.  63. — Long-Sitting. 


72 


SWEDISH  MOVEMENTS 


Fig.  64. — Half -Long-Sitting.     Fig.  65. — Straddle-Sitting. 


Fig.  66. — Short-Sitting. 


SWEDISH   MOVEMENTS- 


73 


2.  With  the  Trunk. 


Fig.  67.— Fall-Sitting. 


DERIVATIVE  POSITION  FROM  THE  KNEELING 
POSITION 


Fig.  68. — Side- Kneeling. 


74  SWEDISH   MOVEMENTS 

DERIVATIVE  POSITIONS  FROM  THE  LYING 
POSITION 

See  Fig.   19.     Page  31.     (Crook-lying.) 

The  subdivisions  of  positions  here  mentioned 
have  given  rise  to  a  difficult  terminology,  as  in 
many  of  them  no  equivalent  English  word  can  be 
found.     They   are,    however,    of   great   importance 


Fig.  69. — Sit-lying. 

to  everybody  who  contemplates  practising  Swedish 
movements,  and\s  to  their  practical  use  we  will 
refer   to   them  in  connection  with  the  movements. 


Fig.  70. — Crook-Half-Lying. 

Only  a  few  examples  of  their  importance  will  be 
given  here.  In  the  derivative  positions  of  standing, 
with  the  arms,  we  can  act  upon  certain  parts  or 


SWEDISH   MOVEMENTS  75 

temporarily  prevent  certain  organs  or  tissues  from 
performing  their  functions.  In  the  positions  demon- 
strated in  Figs.  48,  52, 54, 56,  the  chest  is  considerably 
expanded,  which  causes  deeper  inspirations. 

In  cases  of  "round  shoulders,''  "narrow  chest," 
etc.,  it  is  of  great  importance  to  select  the  proper  one 
of  these  derivative  positions  for  the  movement 
that  is  to  be  used. 


DIVISION  OF  MOVEMENTS 


Ling  and  his  pupils  divided  the  movements  into: 

i.  Single. 

2.  Double. 

The  single  movements  they  again  subdivided 
into  passive  and  active,  and  the  double  movements 
into  concentric  and  excentric. 

Passive  movements  are  such  as  are  applied  to 
the  patient  without  his  assistance.  (They  may  be 
performed  by  an  operator,  by  a  machine,  or  through 
the  power  of  gravity.)    ■ 

Active  movements  are  performed  by  the  patient. 
.    Concentric    {active-passive)    movements    are   per- 
formed by  the  patient,  while  the  operator  or  some  other 
power  resists. 

Excentric  {passive-active)  movements  are  performed 
by  some  power  outside  of  the  patient,  while  he  resists. 

The  principal  difference  between  the  concentric 
and  excentric  movements  is  that  in  the  former  the 
muscle  is  shortened,  in  the  latter  it  is  stretched. 
As  to  their  nature  and  physiologic  action,  it  is 
easy  to  understand  that  they  are  but  little  different 
from  the  single  active  movements.  Practically  they 
are  of  great  use,  as  by  them  we  are  able  to  exactly  fix 
the  amount  of  mechanical  work  done  by  the  patient 
in  each  movement. 

76 


SWEDISH   MOVEMENTS  77 

To  make  the  terminology  somewhat  simpler 
for  the  reader,  we  have  in  the  description  of  the 
movements  used  the  expression  duplicated  active 
movements,  by  that  covering  both  concentric  and 
excentric  movements  in  the  Ling  system. 

THE  VARIOUS  MOVEMENTS 


I. 

Rotation. 

2. 

Flexion  and  Extension. 

3- 

Separating  and  Closing. 

4- 

Bending. 

5- 

Raising. 

6. 

Pulling. 

7- 

Turning. 

S. 

Depression  and  Elevation. 

i.  ROTATION 

Rotation  is  a  circular  movement  by  which  the  dif- 
ferent joints  are  brought  into  motion  within  their 
natural  limits. 

I.  Rotation  of  the  feet  may  be  performed  with 
the  patient  in  a  sitting  or  half-lying  position. 

In  the  first  position,  the  operator  sits  in  front  of 
the  patient  and,  taking  the  feet  in  his  lap,  grasps 
the  toes  and  moves  the  feet  outward,  describing  a 
circle.  In  the  second  position,  the  patient  is  half- 
lying,  his  feet  resting  on  the  couch  or  bed.  The 
operator  grasps  the  toes  and  proceeds  with  the  same 


78  SWEDISH  MOVEMENTS 

motion  as  above.     Relax  the  muscles,  if  necessary, 
by  shaking  the  toes. 

The  rotation  of  the  feet  is  intended  to  promote 
circulation  in  the  lower  extremities  and  is  often  used 
for  attracting  the  blood  from  other  parts.  The 
movement  is  performed  fifteen  to  thirty  times.  The 
strength  of  the  motion  depends  upon  the  size  of  the 
circle  described.^   (Passive.) 

II.  Rotation  of  the  Foot. — The  operator,  sitting 
in  front  of  the  patient,  takes  the  heel  in  his  left  hand 
and  grasping  the  toes  with  the  right,  performs  a 
rotatory  motion  from  the  ankle,  pressing  the  foot 
forward.  Ten  to  fifteen  times  in  each  series.  It  is 
used  principally  for  deformities  and  affections  of 
the  feet.     (Passive.) 

III.  Rotation  of  the  Leg. — The  patient  is  in  a 
half-lying  position.  The  operator,  placing  one  hand 
on  the  sole  of  the  foot  and  the  other  below  the  knee, 
with  the  thumbs  inward,  raises  the  leg  and  performs 
a  circular  motion  by  the  hip-joint,  pressing  upward, 
inward  and  outward.  Twelve  to  fifteen  times  on 
each  limb.  It  is  used  to  regulate  the  circulation  of 
the  abdominal  organs  and  to  prevent  stiffness  in 
the  hip-joint.     (Passive  or  Active.) 

IV.  Rotation  of  the  Arms. — The  patient  sitting. 
The  operator,  standing  behind,  grasps  the  extended 
arms  below  the  elbows  and  rotates  them  upward  and 
outward.  The  patient  may  also  be  in  a  standing 
position,  in  which  case  the  operator  must  support 


SWEDISH   MOVEMENTS  79 

him  with  his  chest.     It  is  used  principally  to  assist 
respiration  and  circulation.     (Passive  or  Active.) 

V.  Rotation  of  the  Shoulder. — The  patient  sitting 
or  standing.  The  operator,  putting  one  hand  on 
the  shoulder- joint  and  the  other  below  the  elbow, 
rotates  upward  and  outward.  Fifteen  to  twenty 
times.  The  movement  is  used  for  stiffness  in  the 
joint  and  for  inflammation  of  certain  muscles.  (Pas- 
sive.) 

VI.  Rotation  of  the  Hand. —  The  operator  takes 
the  patient's  hand,  and,  grasping  the  wrist  with  his 
free  hand,  rotates  from  side  to  side.  Ten  to  eighteen 
times.  It  is  used  for  stiffness  in  the  wrist  after 
fractures  of  the  arm;  also  to  increase  the  circulation. 
(Passive.) 

VII.  Rotation  of  the  Head. — The  patient  sitting 
with  the  back  supported.  The  operator,  placing 
one  hand  on  the  forehead  and  the  other  on  the  neck, 
rotates  slowly  from  side  to  side.  Eight  to  ten 
times.  It  is  used  for  anemia  of  the  brain,  stiffness 
of  the  neck,  and  insomnia,  etc.     (Passive.) 

VIII.  Rotation  of  the  Body. — The  patient  in  a 
sitting  position,  with  hands  on  hips.  The  operator 
standing  behind,  places  his  right  hand  on  the  right 
shoulder-blade,  and  his  left  in  front,  on  the  chest  of 
the  left  side,  and  performs  the  motion  in  such  a  way 
as  to  press  the  patient  forward  with  one  hand  and 
carry  him  backward  with  the  other,  always  being 
careful  to 'describe  a  circle.  When  the  movement 
is  performed  to  one  side  ten  to  fifteen  times,  change 


8o 


SWEDISH   MOVEMENTS 


the  position  of  the  hands  and  rotate  toward  the 
other  side.  It  is  used  principally  for  affections  of 
the  abdomen.  To  secure  a  very  strong  action  of  the 
movement,  the  patient  turns  his  body  somewhat  in 
the  motion.     (Passive.) 

IX.  Rotation  of  the  Pelvis. — The  patient  resting 
with  body  on  a  couch  or  bed,  and  grasping  it  to  keep 
immovable,  the  lower  extremities  extended.  The 
operator  grasps  the  feet  and  proceeds  with  the  rota- 


Fig.  71. 

tion  of  the  legs,  endeavoring  to  produce  a  circle  large 
enough  to  bring  the  pelvis  into  action. 

Rotate  ten  times  to  each  side,  if  the  patient's 
strength  permits.     (Passive.) 

This  movement  may  also  be  active  and  is  performed 
as  in  Fig.  71. 

The  aim  of  the  rotation  is  to  lengthen  and  shorten 
the  veins,  so  as  to  produce  a  sucking  of  their  contents, 
thus  stimulating  the  circulation  and  assisting  the  heart 
in  its  action. 


SWEDISH   MOVEMENTS 


8l 


2.  FLEXION  AND  EXTENSION 

I.  Foot. — The  patient  lying  or  sitting.  The 
operator,  grasping  the  ankle  with  one  hand  and  the 
toes  with  the  other,  moves  the  foot  up  and  down  as 
far  as  the  limits  of  the  joint  permit.  Ten  to  eighteen 
times.  It  is  used  for  deformities,  and  especially  for 
stiffness  of  the  Achilles  tendon.  (Passive  and  Dupli- 
cated Active.) 

The  movement  may  also  be  performed  on  both 
feet  at  the  same  time,  as  demonstrated  in  Fig.  72. 


Fig.   72. — Flexion   and   Extension   of   the   Feet. 

II.  Leg. — The  patient  is  in  half -lying  (see  Figs.  75 
and  76)  or  standing  (see  Fig.  74)  position.  The 
operator  places  one  hand  at  the  knee,  the  other  either 
on  top  of  the  instep  or  underneath  the  sole  of  the 
foot. 

The  patient  generally  moves  the  limb  up  and  down 
while  the  operator  resists.     (Duplicated  Active.) 

It  may  also  be  a  passive  movement,  and  is  used  for 


82 


SWEDISH  MOVEMENTS 


stiffness  in  the  knee  and  hip- joint,  and  for  contrac- 
tion of  certain  muscles. 

In  Fig.  73  we  have  demonstrated  the  single  active, 
standing  flexion  and  extension  of  the  leg.  Until 
the  patient  gets  used  to  the  exercise,  it  is  safest  to 
have  him  grasp  something  to  support  himself  and 
prevent  him  from  falling.     The  effect  of  this  move- 


Fig.  73. — Standing  Flexion  and   Extension  of  the  Leg. 

ment  is  not  confined  to  the  extremity  only,  but  the 
abdominal  muscles  are  strongly  and  effectively  acted 
upon.  It  is  therefore  very  valuable  in  the  treatment 
of  constipation  and  hemorrhoids. 

III.  Arms. — The  patient  sitting.  The  operator, 
standing  behind,  grasps  the  patient's  wrists,  telling 
him  to  keep  his  elbows  close  to  the  body  and  to 
move  the  arms  up  and  down,  the  operator  making 


SWEDISH  MOVEMENTS 


83 


suitable  resistance.     Ten  times.     It  is  a  circulatory 
movement.     (Duplicated  Active.) 

IV.  Arm. — The  patient  sitting.  The  operator, 
standing  in  front,  grasping  the  wrist  with  one  hand 
and  around  the  triceps  muscle  with  the  other,  the 
patient  moves  the  arm  up  and  down,  the  operator 
making  suitable  resistance.     Ten  to  fifteen  times. 


Fig.  74.— Flexion    and    Extension    of    the   Leg. 


The  motion  may  also  be  passive,  and  is  used  for 
acting  upon  the  joints  and  for  certain  local  affections. 
(Passive  or  Duplicated  Active.) 

V.  Hand. — The  patient  sitting.  The  operator,  in 
front,  takes  the  fingers  firmly  in  one  hand,  the  other 
grasping  the  wrist,  and  works  up  and  down,  about 
ten  times.  It  is  used  for  stiffness  of  the  wrist, 
sprains  and  for  writer's  cramp.  (Passive  or  Dupli- 
cated Active.) 


84 


SWEDISH   MOVEMENTS 


/E^. 


JTOli 


Fig.  75. 


Fig.  76. 


SWEDISH  MOVEMENTS 


85 


Flexion  and  extension  are  used  principally  for 
regulating  the  circulation  in  certain  parts  and  for 
relieving  local  congestion. 


Fig.  77. 


3.  SEPARATING  AND  CLOSING 

I.  Arms. — The  patient  sitting  with  arms  extended. 
The  operator,  standing  in  front,  grasps  his  wrists; 
the  patient  moves  his  arms  out  and  in,  the  operator 
resisting.  It  is  used  for  expanding  the  chest  and 
in  spinal  curvatures.,  (Duplicated  Active.)     (See  Fig. 

77-) 

II.  Legs. — The  patient  sitting,  or  half -lying.  The 
operator  grasps  the  ankles  underneath,  the  patient 
separates  and  closes  his  legs;  with   the  resistance 


86  SWEDISH   MOVEMENTS 

of  the  operator,  who  may  need  an  assistant.  (Dupli- 
cated Active.) 

This  movement  acts  upon  different  abdominal 
organs. 

III.  Knees. — The  patient  in  a  half-lying  position, 
with  the  knees  flexed.  The  operator,  standing 
at  his  side,  places  one  hand  on  each  knee  and  resists 
the  patient,  who  separates  and  closes  his  legs. 
Eight  to  sixteen  times.     (Duplicated  Active.) 

4.  BENDING 

I.  Head. — The  patient,  sitting  or  hanging,  bends 
the  head  backward  and  forward  eight  to  ten  times. 
It  is  used  to  force  the  blood  to  the  head  in  anemia 
of  the  brain,  and  to  act  upon  the  muscles  of  the  back 
in  lateral  curvature  of  the  spine.  (Active  or 
Duplicated  Active.) 

In  Figs.  78  and  79,  we  have  demonstrated  the 
active  bending  of  the  fread  forward  and  backward, 
and  to  the  sides  respectively.  These  are  used 
when  we  wish  to  draw  the  blood  from  the  head  in 
full  blooded  individuals  or  when  we  wish  to  develop 
the  neck.  The  patient  resists  himself  while  perform- 
ing the  movement. 

II.  Body  (sideways). — Suppose  a  case  of  lateral 
curvature  of  the  spine.  If  the  right  side  is  the 
originally  affected  one,  i.e.,  right  sided  convexity, 
the  patient  stands  with  his  left  arm  straight  up, 
close  to  the  head.     The  operator,  standing  behind, 


SWEDISH  MOVEMENTS 


87 


Fig.  78. 


Fig.  79- 


Fig.  "8o, 


Fig.  81. 


ss 


SWEDISH  MOVEMENTS 


Fig.  82. 


Fig.  83. 


..y    ? 


Fig.  84. 


SWEDISH  MOVEMENTS 


89 


places  one  hand  on  the  right  side,  at  the  highest 
point  of  curvature,  the  other  on  the  opposite  hip; 
the   patient    bends    slowly   toward   the  right   side, 


Fig.  85. 


thus  acting  upon  the  affected  muscles.     The  move- 
ment may  also  be  single  active,  as  shown  in  Fig.  80. 
Bending  of  the  body  sideways  may  also  be  per- 
formed in  a  sitting  position  (see  Fig.  81),  or  as  a 


Fig.  86. 


single  active  movement  from  side  to  side  as  shown 
in  Fig.  84.  This  is  particularly  recommended  when 
we  wish  to  act  upon  the  liver  or  spleen.     It  should 


go 


SWEDISH   MOVEMENTS 


be  performed  slowly,  otherwise  the  patient  is  apt 
to  become  dizzy. 

III.  Body  (forward  and  backward). — The  patient 
is  standing  with  the  hands  on  hips  (see  Fig.  82) 
or  with  the  arms  stretched  (see  Fig.  83).  He  bends 
slowly  forward  and  backward,  being  careful  to  keep 
the  heels  together.     (Active.) 

IV.  Trunk  (up  and  down). — See  Figs.  85  and  86. 


Fig.  87. 

This  movement  should  only  be  used  on  strong 
individuals,  it  being  very  effective.  (Duplicated 
Active.) 

V.  Trunk  (backward). — The  patient  is  sitting 
at  the  edge  of  a  sofa  or  lounge.  The  operators  stand 
behind  and  support  as  shown  in  Fig.  87.  The  patient 
bends  his  trunk  backward  while  the  operators  resist, 
and  the  patient  resists  while  the  operators  raise 
him  up. 

The  support  should  be  made  firm,  so  that  the 


SWEDISH   MOVEMENTS 


91 


patient  feels  confident  in  performing  the  movement. 
It  is  an  excellent  exercise  to  act  upon  the  muscles 
of  the  back.     (Duplicated  Active.) 

VI.  Knee. — The  operator  stands  behind  the 
patient,  as  demonstrated  in  Fig.  88,  and  resists 
the  patient  rising.     (Duplicated  Active.) 


VII.  Knees. — The  patient  stands  with  the  hands 
on  the  back  of  his  head  or  supported  as  in  Fig.  89. 
The  patient  is  told  to  rise  on  his  tip-toes,  flex  his 
knees  as  much  as  possible,  rise  up  on  the  tip-toes 
and  to  regain  standing  position.  The  operator 
supports  either  as  shown  in  Fig.  89  or  with  one  hand 
on  the  chest  and  the  other  on  the  back.  It  may  also 
be  single  active  as  shown  in  Fig.  90.  This  movement 
is  called  "Deep  Knee-Bend." 


92 


SWEDISH   MOVEMENTS 


Fig.  89. 


Fig.  90. 


SWEDISH   MOVEMENTS 


93 


5.  RAISING 

I.  Leg. — The  patient  lying  on  his  back.  The 
operator  grasps  the  heel  underneath,  one  hand  sup- 
porting the  knee  on  top  and  raises  the  extended  leg 
upward.     Ten  times. 

This  movement  may  also  be  active  and  is  used 
principally  for  sciatica  and  slight  rupture. 


Fig.  91. 

IT.  Legs. — The  patient  is  lying  flat  on  his  back 
with  the  limbs  extended  as  shown  in  Fig.  91.  The 
operator  grasps  over  the  shoulders  and  presses  the 
trunk  down,  while  the  patient  raises  the  limbs  up- 
ward far  enough  to  have  them  form  a  right  angle 
with  the  trunk  at  the  hip.  The  movement  acts 
firmly   upon   the    abdomen.     (Duplicated   Active.) 

III.  Body. — The  patient  sitting  on  a  stool  or  a 
turned  chair.  The  operator  places  his  hands  flat 
on  the  shoulder-blade.  The  patient,  if  strong 
enough,  clasps  his  hands  on  the  back  of  his  head  and 
bends  forward,  keeping  the  head  up.  He  then  raises 
his  body  up,  with  a  strong  resistance  of  the  operator. 


94  SWEDISH   MOVEMENTS 

It  is  used  for  deformities  of  the  back.     (Duplicated 
Active.) 

IV.  Body. — The  patient  lying  with  hands  clasped 
on  the  back  of  his  head.  The  operator  places  his 
hands  around  the  ankles,  with  thumbs  inverted,  and 
holds  them  firmly.  ,The  patient  then  rises  slowly 
to  a  sitting  position.  There  is  no  better  move- 
ment for  compressing  the  contents  of  the  bowels. 
The  movement  may  also  be  general  active,  and  is 
used  principally  for  constipation.  (Duplicated  Ac- 
tive or  Active.) 


V.  Body. — The  movement  may  also  be  performed 
with  the  trunk  extended  from  the  lounge,  as  shown 
in  Fig.  92.  It  is  then  very  effective,  and  should  be 
used  with  great  consideration. 

VI.  Body. — Another  form  of  raising  the  body  in 
standing  position  is  demonstrated  in  Fig.  94.  The 
operator  is  sitting  in  front  of  the  patient  and  resists 
him  firmly  in  his  rising.     (Duplicated  Active.) 

Body. — The  movement  may  also  be  performed  as 
shown  in  Fig.  93.  The  patient  is  lying  on  a  bed  or 
couch  the  lower  extremities  out,  feet  on  the  floor 


SWEDISH   MOVEMENTS 


95 


Fig.  93. 


Fig.  94. 


96 


SWEDISH   MOVEMENTS 


and  arms  stretched.  He  is  told  to  slowly  rise  to  a 
sitting  position.  This  exercise  acts  strongly  upon 
the  muscles  of  the  abdomen  and  chest. 

VII.  Chest. — The  patient  sitting.     The  operator 
standing  behind  and  placing  his  hands  around  the 


Fig.  95. 

patient's  armpits  in  front,  raises  the  body  slowly 
forward,  upward  and  backward,  describing  a  circle. 
This  movement  is  always  passive,  and  is  used  to 
assist  respiration  (see  Fig.  95). 

When  performing  this  movement  the  operator 
should  be  careful  not  to  press  the  patient  too  much 
forward  in  the  beginning. 

OSTROM'S  COMBINED  RESPIRATORY  MOVEMENT 

The  patient  stands  erect  with  head  thrown  back 
and  arms  extended  on  a  level  with  his  shoulders. 


SWEDISH   MOVEMENTS 


97 


i.  Flex  the  arms  slowly  under  slight  resistance 
(single  active),  gentle  inspiration. 

2.  Expiration. 

3.  Raise  the  flexed  arms  up  so  that  the  points 
of  the  elbows  reach  above  the  head,  with  deep 
inspiration. 

4.  Expiration  while  in  this  position. 


Fig.  96. 


5.  Bring  the  still  flexed  arms  downward  and  back- 
ward as  far  as  possible  with  a  deep  inspiration. 
The  head  should  be  as  far  back  as  possible  so  as  to 
help  expand  the  chest  to  its  fullest  capacity. 

6.  Expiration. 

7.  The  arms  are  raised  up  on  a  level  with  the 
shoulders  with  deep  inspiration. 


9« 


SWEDISH   MOVEMENTS 


8.  The  arms  are  extended  back  to  their  fundamen- 
tal position  slowly,  while  the  patient  exhales. 

This  movement  is  very  strong  and  consequently 
rather  tiresome  to  the  patient.  It  should  therefore 
be  given  carefully  in  the  beginning. 


6.  PULLING 


I.  Leg. — The  patient  standing  on  a  chair,  with 
hands  against  the  wall  for  support  (see  Fig.  96). 


'Fig.  97. 


The  operator,  grasping  the  foot  around  the  instep, 
carries  the  leg  backward.     Eight  to  fifteen  times. 

The  movement  is  abducent,  as  it  causes  a  great 
tension  in  the  front  part  of  the  abdomen.     (Passive.) 

II.  Leg. — Another  form  of  pulling  of  the  leg  in 
sitting  position  is  demonstrated  in  Fig.  97.  The 
patient  draws  the  limb  upward  with  the  operator's 
resistance;  the  operator  pulls  the  limb  down  to 
the  original  position. 


SWEDISH   MOVEMENTS 


99 


III.  Body  (backward). — The  patient  kneeling  on 
the  sofa,  with  knees  separated;  hands  on  hips.  The 
operator  stands  behind,  with  one  knee  supporting 
the  lumbar  region,  his  hands  grasping  the  armpits 
from  behind,  and  carries  the  patient  slowly  backward 
(see  Fig.  98);  the  latter  making  slight  resistance. 
Six  to  twelve  times,  according  to  strength.  (Du- 
plicated Active.) 


Fig.  98. 


The  movement  has  a  strong  effect  upon  the  abdo- 
men, and  is  used  principally  for  case  of  painful 
menstruation. 

IV.  Body. — The  position  of  operator  and  patient 
is  shown  in  Fig.  99.  The  operator  pulls  the  body 
backward,  being  careful  to  see  that  the  bent  position 
of  the  body  is  kept  all  through  the  movement. 


IOO  SWEDISH   MOVEMENTS 

7.  TURNING 

I.  Foot. — The  patient  sitting  or  lying.  The 
operator  puts  one  hand  back  of  the  ankle,  the  other 
grasping  the  toes  and  the  front  of  the  foot,  and 
turns  the  foot  from  side  to  side.  The  movement  is 
always  passive,  and  is  used  chiefly  for  sprains  and 
deformities. 


Fig.  99. 

II.  Leg.— The  patient  lying.  The  operator  places 
one  hand  at  the  sole  of  the  foot,  the  other  pressing  on 
the  knee  to  keep  the  leg  extended,  thumbs  inward, 
and  moves  the  limb  slowly  inward  and  outward. 
The  motion  is  used  for  stiffness  in  the  hip  joint  and 
for  contraction  of  certain  muscles.     (Passive.) 

III.  Body. — The  patient  standing  (see  Fig.  100)  or 
sitting  Fig.  101),  with  hands  on  the  hips  or  clasped 


SWEDISH   MOVEMENTS 


IOI 


on  the  back  of  the  head.  The  operator,  standing 
behind,  places  his  right  hand  on  one  shoulder  and  his 
left  in  front  of  the  other,  and  moves  the  patient  to 
one  side  and  back  again,  changing  the  position  of  the 
hands  before  turning  to  the  other  side.  The  move- 
ment is  also  duplicated  active,  and  is  used  for  con- 
gestion of  the  abdominal  organs  and  for  acting  upon 
its  great  venous  system. 


Fig.  ioo. 


Fig.  ioi. 


In  Figs.  103,  104,  105  and  106  we  have  depicted 
certain  modifications  of  turning  of  the  body.  The 
one  shown  in  Fig.  106  should  be  used  with  great  care, 
it  being  very  effective,  especially  in  the  case  of  a 
woman. 

Fig.  104  shows  how  the  turning  of  the  body  is  per- 
formed as  a  single  active  movement.  It  acts  strongly 
upon    the    abdominal  viscera,   especially  upon  the 


102 


SWEDISH   MOVEMENTS 


liver.     The  patient  should   be   told   to   take   deep 
breaths  while  performing  the  exercise. 


Fig.  104. 

IV.  Arm. — The  patient  sitting  or  standing.     The 
operator,  supporting  the  elbow  with  one  hand  and 


SWEDISH   MOVEMENTS 


IO3 


Fig.  105. 


Fig.  106. 


Fig.   107. 


104  SWEDISH   MOVEMENTS 

grasping  the  hand  with  the  other,  turns  the  forearm 
from  side  to  side  (pronation  and  supination).  If  the 
whole  arm  is  to  be  turned,  the  operator  must  grasp 
the  elbow  to  keep  it  extended.  The  movement  is 
passive,  and  is  used  principally  for  stiffness  in  the 
joints  and  for  relaxing  the  tendons  and  muscles  in 
cases  of  after-operation. 

V.  Head. — The  patient  sitting.  The  operator, 
placing  one  hand  on  the  forehead,  the  other  on  the 
neck,  moves  the  head  slowly  from  side  to  side.  Ten 
times.     (Duplicated  Active,  Passive.) 

VI.  Pelvis. — The  patient  is  in  a  position  as  shown 
in  Fig.  107.  The  operator  stands  behind  and  resists 
the  patient  in  his  turning  forward  and  backward. 

8.  DEPRESSION  AND  ELEVATION 

I.  Arms. — The  patient  sitting  or  lying.  The 
patient  raises  his  arms,  the  operator  grasping  the 
hands  from  behind.  The  operator  presses  the  arms 
down,  the  patient  resisting.  The  patient  raises 
the  arms  while  the  operator  resists.  Ten  to  twelve 
times.     (Duplicated  Active.) 

In  Fig.  108  is  shown  a  form  of  depression  and 
elevation  of  the  arms  in  which  the  operator  stands 
elevated  in  front  of  the  patient. 

II.  Legs. — The  patient  lying  flat  on  the  back, 
grasping  the  bed  or  couch  to  keep  himself  immovable. 
The  operator  grasps  the  soles  of  the  feet,  thumbs 
inward.     The  movement  is  performed  down  and  up 


SWEDISH   MOVEMENTS 


I05 


with  the  knees  turned  out,  the  patient  resisting  in  the 
elevation  and  the  operator  in  the  depression. 


•v*s 

►             V, 

■c_^"i. 

I 

1 

1 
1 

1 

11 
1 

) 

Fig.  108. 


Fig.  109. 


The  movement  is  very  effective  and  must  be  per- 
formed with  great  care.  Six  toten  times.  (Dupli- 
cated Active.) 


106  SWEDISH   MOVEMENTS 

III.  Leg. — In  Fig.  109  we  have  demonstrated 
depression  of  the  one  leg,  used  for  certain  muscular 
affections  in  the  thigh  and  around  the  pelvis. 

Several  movements  belonging  to  the  Swedish  system 
have  been  omitted  as  not  being  of  much  practical  use. 


THE  PHYSIOLOGY  OF  THE  MOVEMENT 
TREATMENT 


The  movement  treatment  is  not  shrouded  in 
mystery,  nor  is  a  minute  knowledge  of  anatomy  or 
physiology  necessary  to  understand  its  nature  and 
comprehend  its  workings.  Its  physiology  is  very 
simple  and  easily  understood,  because  it  always  en- 
deavors to  follow  the  laws  of  nature. 

Motion  and  activity  are  the  principal  characteris- 
tics of  man;  and  all  parts  of  the  body  are  so  formed 
as  to  fulfil  their  proper  functions. 

By  the  law  of  metamorphosis,  every  particle,  after 
remaining  a  certain  time  in  the  body,  is  cast  off,  to 
be  replaced  by  a  new  one.  This  alteration  is  carried 
on  very  slowly  and  almost  imperceptibly,  but  without 
interruption. 

Every  one  knows  that  it  is  impossible  to  abstain 
from  food  and  not  lose  in  weight  and  flesh.  This 
loss  indicates  that  the  body  is  consuming  itself,  under 
a  chemic  process  called  combustion,  by  which  heat 
is  produced,  and  carbonic  acid,  water,  etc.,  ex- 
creted by  the  lungs,  the  skin,  the  kidneys,  and  the 
intestines. 

107 


108  SWEDISH   MOVEMENTS 

The  process  may  be  too  rapid  or  too  slow.  The 
first  takes  place  in  fevers,  with  their  high  temperature 
and  great  emaciation;  the  second,  in  many  chronic 
disorders,  with  lowered  temperature  and  lowered 
vitality. 

Those  organs  which  are  in  a  state  of  permanent 
activity  are  most  likely  to  suffer  from  overwork; 
but  there  is  danger  of  the  opposite  extreme  in  the 
muscular  system,  so  much  of  which  is  dependent 
for  action  entirely  upon  the  exercise  of  the  will. 

This  great  muscular  system,  with  the  nerves 
and  vessels  by  which  it  is  supplied,  and  the  joints 
which  it  controls,  comprises  about  nine-tenths  of 
the  whole  organism. 

Generally  speaking,  the  action  of  the  voluntary 
muscles  is  reduced  to  a  minimum.  How  much  of 
the  great  muscular  system  has  the  clerk  brought  into 
use?  Only  the  muscles  of  the  arm,  the  rest  remain- 
ing inactive;  and  these  muscles  are  so  overtaxed 
as  to  cause  an  irritation  of  the  nerves  communicating 
with  them,  and  the  result  is  nervous  disorders,  such 
as  writers'  cramp. 

Aside  from  what  their  occupation  affords  them 
(and  that  is  more  or  less  defective),  most  persons 
have  no  other  exercise  than  the  daily  walk  to  and 
from  their  business,  which  rarely  exceeds  an  hour 
a  day.  While  this  exercise  is  better  than  none, 
its  benefits  are  often  overestimated.  In  walking, 
only  certain  muscles  are  actively  engaged,  and  even 
those  very   imperfectly.     The   muscles   of   the   leg 


SWEDISH   MOVEMENTS  IO9 

are  used  in  taking  the  step  and  the  muscles  of  the 
back  in  keeping  the  body  upright,  but  this  exercise, 
with  its  uniform, nature,  is  of  less  value  than  any- 
other. 

It  is  necessary  to  give  the  muscles  alternate  work 
and  rest.  In  walking,  the  muscles  of  the  back 
are  kept  in  a  permanent  state  of  tension,  so  that 
they  have  not  the  time  perfectly  to  contract  and 
relax,  which  is  essential  to  beneficial  exercise. 

Although,  from  a  purely  hygienic  standpoint 
walking  in  the  pure  air  is  of  great  benefit,  aiding 
respiration,  yet  the  daily  walk  to  a  given  place 
becomes  mechanical  and  automatic,  no  attention 
being  paid  to  the  movements  by  the  will  power. 

It  is  evident  to  all  that  in  the  various  motions 
of  the  body  or  the  limbs  a  change  is  taking  place 
in  some  of  its  tissues  by  means  of  combustion. 

First,  this  activity  creates  heat,  the  intensity 
of  which  can  be  estimated,  but  not  the  amount. 
Second,  a  certain  amount  of  waste  material  is 
thrown  off  and  absorbed  by  the  veins  and  the 
lymphatics,  to  be  eventually  excreted  from  the 
body.  The  creation  of  heat,  which  in  a  few  minutes 
reaches  several  degrees,  is  soon  made  evident  by 
copious  perspiration. 

The  chemic  change  produces  carbonic  acid  and 
other  substances,  which  cause  the  feeling  of  languor. 
The  sense  of  fatigue  remains  until  the  products 
of  the  change  are  carried  away  by  the  blood-vessels 
and  the  lymphatics. 


IIO  SWEDISH   MOVEMENTS 

By  this  process,  which  is  constantly  going  on  in 
the  working  muscles,  some  part  of  the  tissue  is 
consumed  but  the  loss  is  compensated  by  the  nourish- 
ment which  it  receives  from  the  blood. 

This  exercise  demands  a  greater  supply  of  blood 
and  neither  its  quantity  nor  its  quality  can  be 
diminished  without  seriously  endangering  health. 

To  replenish  the  blood,  the  lymphatics  carry 
the  digested  food  (chyle)  from  the  stomach  and 
intestines  into  the  blood-circulation.  But  before  it 
is  in  a  condition  to  nourish  the  body  it  must  be 
carried  to  the  great  vessels  of  the  lungs,  when  it  is 
brought  in  contact  with  oxygen. 

By  proper  exercise  the  respiratory  movements 
become  longer  and  deeper  and  the  capacity  of  the 
lungs  is  very  much  increased. 

The  same  stimulating  effect  is  produced  upon 
the  circulatory  system.  An  increased  amount  of 
blood  is  sent  to  the  different  parts,  necessitating 
a  freer  circulation. 

Thus  we  find  that  exercise  systematically  applied 
produces  direct  and  positive  action  upon  the  cir- 
culatory, digestive  and  respiratory  systems. 

Since  carbonic  acid  gas  and  water  are  carried  off 
through  the  lungs  and  water  and  uric  acid  through 
the  kidneys  and  skin,  we  can  easily  comprehend 
that  exercise  will  aid  materially  in  hastening  the 
elimination  of  bodily  waste. 

Of  course  in  the  process  of  combustion  heat  is 


SWEDISH   MOVEMENTS  III 

necessarily  produced,  and  if  the  excess  is  not  carried 
off,  serious  results  may  ensue. 

In  health,  nature  has  provided  proper  facilities 
for  carrying  off  all  heat  above  the  normal  amount 
by  exhaustion  from  the  skin  and  lungs. 


MECHANICAL  ACTION  OF  MUSCLES 


There  is  also  a  mechanical  process  that  takes  place 
in  every  kind  of  muscular  work,  for  when  the  muscle 
contracts,  its  mass  is  condensed,  and  the  soft  parts 
near  the  muscle  are  exposed  to  a  very  strong  pressure. 

This  fact  has  a  very  important  bearing  upon  the 
veins  and  the  lymphatics,  and  upon  the  fluids  which 
these  vessels  carry  to  the  heart. 

While  the  heart  principally  controls  the  action  of 
these  vessels,  much  aid  is  afforded  them  by  the  tem- 
porary pressure  of  the  contracted  muscles,  and 
thus  we  see  that  exercise  stimulates  and  increases 
the  circulation  in  the  veins  and  lymphatic  vessels. 

But  these  are  not  all  the  results  that  are  produced 
by  proper  exercise.  In  voluntary  muscular  action, 
as  a  rule,  one  or  two  joints  are  set  in  motion. 

These  joints  are  protected,  to  prevent  their  bony 
surfaces  from  coming  in  contact  with  each  other. 
While  the  motion  is  a  rubbing  or  friction  movement, 
exercise  properly  taken  is  free  from  all  danger; 
moreover,  the  joint  is  decidedly  benefited  by  such 
action,  nutrition  to  the  part  being  increased. 

Generally,  where  the  muscles  are  attached  to  the 
bones  large  processes  or  elevations  are  found;  and 
the  greater   the  muscles  the  larger   the  processes. 

112 


SWEDISH   MOVEMENTS  113 

This  must  indicate  an  increased  nutrition  to  the 
bone,  as  well  as  increased  strength  to  the  osseous 
system. 

The  effect  of  exercise  is  not  only  chemic  and  me- 
chanic, but  also  physiologic. 

The  voluntary  movements  are  what  distinguish 
animals  from  plants. 

The  higher  we  go  in  the  scale  of  animal  life,  the 
more  perfect  is  the  mechanism  for  executing  the 
various  movements  necessary  to  its  existence.  We 
find  a  finer  muscular  development  in  connection 
with  a  more  highly  developed  nervous  system. 

Involuntary  motions  are  adjusted  by  the  sympa- 
thetic nervous  system,  while  the  voluntary  movements 
are  controlled  and  regulated  by  the  cerebrospinal 
nervous  system. 

That  mysterious  power  which  we  call  will  imparts, 
at  times,  an  impulse  to  muscular  activity,  and  at 
others  it  restrains  and  impedes  it. 

Whatever  the  nature  of  the  will,  we  know  that 
when  an  impulse  is  generated  in  the  brain  it  is  carried 
to  the  nerves  of  the  spinal  cord,  and  from  them  to  the 
peripheral  nerves,  and  thence  to  the  muscles,  which 
causes  what  we  call  contraction. 

Thus  we  see  that  exercise  is  not  so  simple  a  thing 
as  is  commonly  supposed,  but,  on  the  contrary,  it  is  a 
complex  process  involving  the  brain,  the  spine,  the 
nerves,  and  the  muscles. 

As  the  activity  of  a  muscle  produces  a  constant 
change  in  the  circulation,  so  this  same  action  will 


114  SWEDISH  MOVEMENTS 

greatly  influence  the  substance  of  the  nerves  them- 
selves. 

This  applies  only  to  motor  nerves,  although  some 
authors  claim  that  exercise  has  an  indirect  effect 
upon  the  central  nervous  system. 

At  times  physicians  employ  certain  remedies 
called  derivatives,  the  object  of  which  is  to  relieve 
certain  parts  of  the  body.  For  instance,  by  the  use 
of  purgatives,  to  relieve  portal  congestion  or  to  re- 
move a  sluggish  circulation  in  the  brain.  In  some 
mental  disorders,  as  in  melancholy  or  hysteria,  the 
same  theory  directs  that  the  mind  should  be  con- 
stantly employed,  so  that  the  patient  may  have  no 
time  to  think  of  himself. 

Again,  when  there  is  a  disturbance  in  the  normal 
condition  of  the  motor  nerves,  as  in  spasms,  it  may 
be  removed  by  a  strong  and  decided  impression  upon 
tne  central  nervous  system  through  sorrow,  sudden_ 
terror,  etc.,  or  by  an  impression  upon  the  nerves,  by 
burning.   .. 

When  there  is  any  disturbance  in  the  central 
nervous  system,  we  can  often,  by  employing  agents 
to  act  upon  the  motor  nerves,  remove  its  cause. 

We  reach  this. conclusion  because  persons  suffer- 
ing from  irritation  of  the  central  nervous  system 
are  generally  those  who  use  their  motor  nerves  but 
little.  Again,  it  is  a  common  experience  for  the  well- 
trained  masseur  to  see  these  patients  improve  very 
rapidly,  and  be  finally  cured  by  fixed  duplicated 
active  movements. 


SWEDISH  MOVEMENTS  115 

Thus  we  conclude  that  active  movements  have  a 
beneficial  effect  upon  the  nervous  system,  direct  upon 
the  motor  nerves,  and  indirect,  upon  the  central  nerves. 

What  we  have  said  about  the  effects  of  the  move- 
ments has  been  of  a  general  character,  but  it  is 
necessary  to  understand  the  local  effects  upon  the 
different  organs  of  the  body. 

When  treating  a  local  affection,  the  movements  or 
manipulations  are  to  be  applied  in  such  a  way  that 
the  affected  part  will  derive  the  benefit.  When  the 
circulation  is  feeble  in  certain  parts,  the  muscles  in 
the  neighborhood  must  be  made  to  act,  so  that  the 
blood  will  circulate  more  freely  in  the  part  diseased. 


APPLICATION  OF  MASSAGE  AND  THE 

SWEDISH  MOVEMENTS  TO  VARIOUS 

DISEASES  OF  THE  BODY 


The  movement  treatment,  being  an  invigorating 
remedy,  is  recommended  principally  for  chronic  dis- 
eases where  either  the  whole  organism  or  only  a  part  is 
weakened. 

The  prescriptions  of  massage  and  movements; 
given  here  are  only  mentioned  in  a  general  waye  the 
operator  must  use  them  only  after  a  careful  con- 
sideration. What  may  be  beneficial  to  one  indi- 
vidual may  injure  another. 

The  operator  should  consequently  use  such  move- 
ments and  manipulations  as  he  finds  suitable  to  the 
individual  case,  in  the  meantime  being  guided  by  the 
prescriptions  here  mentioned. 

It  is  necessary  in  all  cases  to  note  how  the  patient 
bears  each  movement.  If  any  are  too  strong,  they 
must  be  omitted,  only  to  be  resumed  as  the  patient's 
strength  increases. 

During  the  first  treatments  great  care  should 
be  taken  not  to  overtax  the  patient's  strength; 
it  is  always  better  to  do  too  little  than  too  much — -the 
one  is  much  easier  remedied  than  the  other. 

116 


MASSAGE    AND   MOVEMENTS    IN    TREATMENT    117 

GENERAL  WEAKNESS 

Apply  general  massage.  Follow  with  passive 
flexions  and  extensions,  rotations  and  pressings. 
Finally  give  percussion  of  the  back,  if  the  patient's 
strength  permits. 

The  first  treatments  should  last  from  twenty 
to  thirty-five  minutes,  gradually  increasing  to  an 
hour  at  the  end  of  the  first  week.  Daily  treatments 
are  often  necessary. 

Under  this  heading  come  most  of  the  affections 
or  rather  conditions  treated  by  general  massage; 
for  instance,  when  a  patient  is  convalescent  after 
fevers  (typhoid,  scarlatina),  after  operations,  when 
the  body  is  emaciated,  in  many  conditions  of  nervous 
disorders,  and  in  general  when  we  propose  the  treat- 
ment as  a  tonic  instead  of  outdoor  exercise. 

-   .  - 
ANEMIA 

For  this  disease  some  authors  recommend  general 
massage  of  the  whole  body,  others  recommend  a 
complete  series  of  movements.  A  series  of  well 
selected  movements  in  connection  with  the  general 
massage  will  perhaps  be  the  most  effective  agent  in 
renewing  the  blood.  The  treatment  must  be  only 
by  passive  movements,  and  such  as  will  aid  the 
digestion,  the  circulation  and  the  respiration. 

When  the  patient  is  very  feeble,  use  only  the 
general  massage,  gradually  commencing  with  the 
movements  as  the  strength  increases.  All  exercises 
should  be  passive,  so  as  not  to  overtax  the  patient. 


Il8    MASSAGE   AND    MOVEMENTS   IN  TREATMENT 

The  following  series,  recommended  by  Professor 
Hartelius,  of  Stockholm,  Sweden,  has  frequently 
been  used  with  success: 

i.  S.  rotation  of  the  arms.1 

2.  Half  L.  rotation  of  feet. 

3.  Massage  of  abdomen. 

4.  S.  rotation  of  arms. 

5.  S.  rotation  of  body. 

6.  Half  L.  flexion  and  extension  of  legs. 

7.  St.  percussion2  of  back. 

The  first  movement  is  for  respiration,  extending 
the  chest.  The  air  is  inspired  more  freely  and  a 
greater  quantity  of  oxygen  brought  in  contact  with 
the  blood.  Eight  to  twelve  times.  The  second 
carries  the  blood  to  the  feet,  which  are  generally 
cold;  the  third  aids  digestion  and  increases  the  ap- 
petite; the  fourth,  see  1;  the  fifth  affects  the  great 
venous  system;  the  sixth  increases  circulation  in  the 
lower  extremities;  the  seventh  has  a  refreshing 
action  on  the  whole  system. 

The  movements  are  scientifically  arranged  to 
remove  the  tired  feeling,  the  loss  of  appetite,  the  cold 
hands  and  feet,  the  backache,  and  all  symptoms 
we  find  in  an  anemic  patient. 

If  there  be  any  abdominal  affections,  special 
attention  must  be  paid  to  them  in  the  selection 
of  the  movements. 

XS.  means  sitting;  St.,  standing;  L.,  lying;  Kn.,  kneeling;  Sp., 
suspending. 

2  Whenever  the  expression  "percussion"  is  used,  the  author  means 
hacking. 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     119 

HYSTERIA 

For  hysteria  we  use  such  manipulations  as  will 
act  directly  upon  the  peripheric  nervous  system. 
The  general  massage,  followed  by  a  few  rotary 
movements  of  the  extremities,  is  to  be  recommended. 

CHOREA 

If  the  disease  has  advanced  so  far  that  the  child 
has  no  control  whatever  over  the  limbs,  place  him 
on  a  couch  or  bed,  one  operator  standing  at  the  head, 
holding  the  arms,  another  standing  at  the  feet, 
grasping  the  lower  extremities.  Begin  with  gentle 
stroking  with  the  palm  of  the  hand  over  the  ex- 
tremities and  the  chest,  gradually  increasing  the 
strength;  then  turn  the  patient  over  on  his  face, 
and  continue  the  firm  stroking  over  the  back  and 
neck.  The  full  treatment  should  last  an  hour,  and 
be  repeated  daily  four  or  five  times.  (Blache.)  As 
soon  as  improvement  is  visible,  begin  with  certain 
passive  movements,  such  as  flexion  and  extension 
of  the  extremities,  separating  and  closing  of  the 
knees,  bending  of  the  head,  depression  and  elevation 
of  the  arms. 

The  patient  is  soon  able  to  take  duplicated  active 
movements,  and  is  finally  instructed  in  general 
active  movements  or  calisthenics,  the  operator 
keeping  exact  time. 

Strong,  persistent  treatment  every  day,  with  spe- 
cial attention  to  the  duplicated  active  movements, 


120    MASSAGE    AND    MOVEMENTS    IN   TREATMENT 

will  yield  good  results. — Functional  spasm  often 
yields  to  persistent  massage  treatment  whereas 
hysterical  spasm  offers  more  resistance. —  [Editor.] 

PLETHORA 

In  this  affection  we  use  movements  such  as  will 
attract  the  blood  from  the  head  and  produce  muscu- 
lar activity. 

The  most  important  part  of  our  treatment  is 
the  massage  of  the  neck  and  head.  By  the  former 
we  can  relieve  the  blood-pressure  on  the  brain  to  a 
remarkable  extent,  the  patient  often  after  the  treat- 
ment telling  us:  "How  much  lighter  my  head  feels." 
Both  methods  of  massage  of  the  neck  may  be  used, 
but  that  of  HoefTmger  should  be  selected  as  the  in- 
troductory massage,  to  reach  the  deeper  veins  and 
give  an  outlet  for  the  congested  circulation. 

i.  Massage  of  neck  and  head. 

2.  Half  L.  rotation  of  leg. 

3.  S.  rotation  of  body. 

4.  Half  L.  rotation  of  feet. 

5.  S.  rotation  of  head. 

6.  Kn.  turning  of  body. 

7.  Beating  of  sacrum. 

8.  S.  rotation  of  arms. 

9.  S.  percussion  of  head,  with  shaking  and  stroking. 

INSOMNIA 

There  are  certain  movements  which  so  affect  the 
central  or  the  sympathetic  nerve-system  that  they 
are  called  by  some  authors  "sleeping-movements." 


MASSAGE    AND   MOVEMENTS   IN   TREATMENT     121 

As  a  rule,  the  general  active  movements  are  suffi- 
cient. The  treatment  should  always  be  applied 
at  bedtime.  The  following  manipulations  and  treat- 
ments will  prove  beneficial: 

i.  Light  general  massage. 

2.  S.  Depression  and  elevation  of  arms. 

3.  Half  L.  flexion  and  extension  of  legs. 

4.  S.  turning  of  body. 

5.  Separating  and  closing  of  arms. 

6.  L.  raising  of  body. 

7.  St.  bending  of  knees. 

8.  Massage  of  neck  and  head. 

9.  Head  clapping  and  stroking. 

HEADACHES 

During  the  past  few  years  the  author  has  had  such 
exceptional  results  in  the  treatment  of  peripheral 
headaches  that  he  wishes  to  pay  some  special  atten- 
tion to  their  treatment  by  massage.  It  has  been 
clearly  established  that  many  cases  of  headaches 
with  negative  eye-conditions  have  been  cured  by 
thorough  massage  of  the  neck  and  head.  Dr. 
Gustaf  Norstrom  has  shown  us  in  his  excellent 
little  book  on  headaches,  that  many  of  these  cases 
are  caused  by  myositic  deposits  in  the  neck,  generally 
in  the  nape,  but  frequently  also  in  the  respective 
anatomical  extremes  of  the  neck.  This  may  seem 
rather  strange  to  many,  but  the  trained  masseur 
knows  and  almost  daily  experiences  the  fact  that  the 


122     MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

"  spontaneous  pain  has  not  always  the  same  seat  as 
the  lesion." 

The  cases  are  readily  defined;  the  oculist  reports 
that  there  is  no  condition  of  the  eyes  that  could 
possibly  cause  the  suffering.  Then  let  us  carefully 
examine  the  neck  and  head.  The  first  thing  to 
look  for  is  this:  is  there  a  cerebral  congestion  of 
some  standing?  Hoeffinger's  method  of  massage  of 
the  neck  will  tell  us  that.  We  as  a  rule  find  this 
congestion,  particularly  in  the  plethorics  who  have 
obstructions  to  the  circulation  in  the  upper  part 
of  the  trunk.  In  the  nape  of  the  neck  we  find  many 
lumps  or  myositic  deposits,  which  in  contradistinc- 
tion to  the  ganglia  and  lymphatic  glands  are  movable 
only  with  the  particular  muscle  of  which  they  form 
a  part.  Pressing  of  a  myositic  deposit  will  cause 
acute  pain,  often  extending  to  the  supraorbital  nerve 
and  eyelid  of  the  corresponding  side.  These  deposits 
may  be  recognized  in  three  stages  or  degrees  (Nor- 
strom) :  we  may  have  a  swelling  only,  or  a  resistive 
touch,  or  an  actual  induration  where  the  consistency 
is  very  hard  and  the  deposit  consequently  well 
defined. 

Now  to  the  practical  application  of  masssage  for 
headaches.  First  of  all  we  must  give  strong,  thor- 
ough strokings  with  both  hands  from  the  base  of  the 
skull  to  the  acromion  processes.  This  is  our  intro- 
ductory massage  to  relieve  not  only  the  cerebral 
congestion,  but  also  the  pronounced  congestion  of  the 
nape  of  the  neck.     The  first  few  treatments  should 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT      1 23 

consist  of  these  manipulations  only,  with  a  few 
strokings  of  the  head  added,  but  as  soon  as  we  can 
clearly  define  the  deposits  we  commence  with  our 
strong  frictions  and  kneadings,  picking  up  the  lump 
separately  and  squeezing  it  between  the  thumb  and 
fingers.  This  causes  pain  often  to  such  a  degree  that 
it  becomes  necessary  to  allow  the  patient  some  rest 
occasionally;  the  whole  treatment  Should  never 
exceed  twenty  minutes,  and  by  that  time  not  only 
the  patient  but  also  the  operator  has  had  enough! 
The  patient  should  be  compelled  to  take  a  rest  in 
a  recumbent  position  for  fifteen  minutes  after  the 
treatment. 

It  is  not  sufficient  to  massage  the  muscles  and  their 
deposits  only  but  the  nerves  of  the  scalp  and  of  the 
forehead  should  receive  attention,  particularly  in 
those  cases  where  we  are  able  to  find  local  structural 
changes. 

In  regard  to  the  Swedish  movements  we  have 
principally  the  following  as  the  most  useful: 

1.  Susp.  bending  of  head  (concentric). 

2.  Sitting  bending  of  head. 

3.  St.  bending  of  turned  body  sideways. 

4.  Sitting  turning  of  the  head. 

5.  Ostrom's  combined  resp.  movement  (see  page 

96). 

In  the  movements  marked  3  and  5  the  reader  will 
notice  that  the  author  wishes  to  act  upon  the  organs 
of  the  trunk  which  are  apt  to  become  congested, 
especially  the  liver.     I  have  had  several  cases  of 


124  MASSAGE  AND  MOVEMENTS  IN  TREATMENT 

headaches  in  plethorics  which  did  not  yield  at  all 
until  I  carefully  treated  the  liver. 

It  is  well  to  mention  that  in  all  cases  the  author 
has  watched  and  treated,  there  was  invariably  either 
a  history  of  gout,  rheumatism  or  a  congested  liver 
with  distended  gall-bladder.  Consequently  we  must 
not  lose  sight  of  the  necessity  of  proper  diet  and  medi- 
cation to  prevent  the  further  formation  of  deposits — 
massage  is  effective  only  for  what  has  been  formed 
by  impaired  digestion  and  stored  up  in  the  muscles 
by  locally  impaired  circulation. 

APOPLEXY 

Experience  shows  that  even  old  cases  of  paralysis 
are  very  often  improved,  and  sometimes  completely 
cured,  by  mechanotherapy.  Its  advantages  consist 
in  being  able  to  work  upon  the  entire  nerve-system  as 
soon  as  the  least  activity  is  apparent  in  the  affected 
side. 

The  massage  is  used  at  first  to  stimulate  the  nerves 
and  to  increase  nutrition.  It  will  always  be  of  some 
benefit,  provided  the  system  has  power  to  react. 

In  treating  a  case  of  paralysis  the  operator  should 
remember  two  special  points : 

i.  Find  out  which  muscles  are  affected  and  treat 
them  and  their  nerve-supplies  with  massage. 

2.  Overcome  the  contraction  of  the  antagonists  by 
movements,  or  if  necessary  by  braces. 

Where  there  is  active  power  in  the  affected  side, 


MASSAGE   AND   MOVEMENTS   IN   TREATMENT     1 25 

use,  in  connection  with  the  massage,  the  following 
movements  (for  instance,  for  the  right  side) : 

1.  S.  rotation  of  arms. 

2.  Half  L.  rotation  of  legs. 

3.  S.  rotation  of  right  shoulder. 

4.  Flexion  and  extension  of  right  leg. 

5.  Depression  and  elevation  of  right  arm. 

6.  Pressing  and  shaking  of  right  leg. 

7.  Pressing  and  shaking  of  right  arm. 

8.  Percussion  of  back. 

It  is  generally  the  best  plan  not  to  start  the 
massage  until  three  weeks  after  the  stroke.  The 
operator  should  always  remember  to  select  such 
manipulations  and  movements  as  will  prevent  a 
rush  of  blood  to  the  cerebrum. 

Paralysis  from  accident,  gout  or  rheumatism,  is 
very  often  treated  by  massage,  the  result  depending 
upon  the  condition  of  the  affected  nerves.  When 
caused  by  poison,  mechanotherapy  is  recommended 
principally  as  a  stimulating  remedy,  when  the 
patient  is  convalescent.  In  paralysis  from  lead- 
poisoning  massage  is  an  excellent  remedy. 

The  necessity  of  a  knowledge  of  anatomy  on  the 
part  of  the  operator  is  more  apparent  in  treating 
cases  of  paralysis  than  any  others.  Careful  atten- 
tion should  be  paid  to  the  facial  muscles  if  required. 

In  a  Swedish  journal  is  recorded  a  case  of  an  eight- 
een-year-old patient  paralyzed  in  one  leg  from  child- 
hood. He  was  treated  twice  daily  for  three  consecu- 
tive years  by  thorough  massage  and  movements,  and 


126    MASSAGE   AND   MOVEMENTS   IN   TREATMENT 

at  the  age  of  twenty-one  his  leg  was  restored  to  its 
natural  size  and  strength. 

It  is  astonishing  what  the  inunction  of  cod-liver 
oil  in  connection  with  the  massage  will  do  in  some 
cases  of  paralysis. — Recent  experiments  in  the  treat- 
ment of  cerebral  paralysis  have  advanced  the  theory, 
that  by  immobilization  of  corresponding  unaffected 
muscles,  the  paralyzed  ones  quicker  regain  normal 
function . — [Editor.] 

INFANTILE  PARALYSIS 

In  this  obscure  and  troublesome  affection  scientific 
massage  has  won  some  of  its  greatest  victories.  With 
the  aid  of  the  electric  current  we  first  find  out  which 
muscles  or  which  groups  of  muscles  are  affected. 
This  should  not  be  done  however  until  one  full 
month  from  the  day  of  the  first  attack.  It  is  a  well 
acknowledged  fact  that  the  amount  of  damage  done 
to  the  tissues  will  all  depend  upon  how  soon  the 
disease  is  properly  recognized,  so  as  to  promptly 
apply  the  counter  irritation  to  both  sides  of  the  whole 
spinal  column. 

When  we  begin  the  massage  we  should  give  strok- 
ings  only  over  the  whole  affected  limb  to  increase 
nutrition  and  tone  up  the  different  parts,  but  the 
deep  massage  should  at  first  be  given  only  to  the 
most  affected  muscles  and  their  nerve  supply,  the 
other  or  stronger  groups  being  severely  let  alone.  In 
my  own  practice  I  have  often  taken  cases  of  this 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     1 27 

trouble  and  in  a  short  time  gotten  the  most  marked 
improvement  simply  by  adhering  to  the  above  rule, 
when  before  the  ordinary  " rubbing-massage"  had 
been  tried  for  a  year  or  more  and  failed  to  give  any 
result.  It  seems  to  me  that  the  attending  physician 
should  plainly  write  out  his  prescription  or  the  mas- 
sage to  be  faithfully  rilled  by  a  competent  operator. 
We  stretch  the  spinal  column  by  movements  or 
better  still  by  suspension  as  the  patient  gains  strength 
and  I  always  arrange  a  horizontal  bar  with  cleats  in  a 
doorway  so  that  I  have  two  heights,  one  for  the  child 
sitting  and  one  for  the  standing  position.  When  the 
braces  are  first  put  on  I  use  a  double  bar  fitting  the 
height  of  the  child  like  a  crutch;  there  is  also  another 
cross-bar  below  to  put  the  hands  on;  the  uprights  are 
slanting  inward  and  only  room  enough  is  given  for  the 
child  to  get  through.  This  is  an  excellent  arrange- 
ment in  the  early  starting  of  teaching  coordination. 
My  next  move  is  generally  to  let  the  child  push  the 
rolling  chair,  if  old  enough;  by  this  time  there  is  more 
coordination,  he  will  begin  to  balance  at  first  for  a 
minute,  then  more  and  more  every  day;  now  we  may 
begin  with  crutches  cut  rather  short  so  as  to  get  a 
slight  forward  bend  which  helps  to  steady  the  patient 
in  balancing;  then  only  one  crutch  and  a  cane  and 
finally  the  one  cane.  Of  course  it  will  be  understood 
that  in  the  meantime  the  child  has  medical  tonic 
treatment  also  electricity  and  hydrotherapy  in  con- 
nection with  the  massage.  The  treatment  must  be 
given  every  day  if  there  is  to  be  any  result  expected. 


128     MASSAGE   AND    MOVEMENTS   IN   TREATMENT 

A  careful  record  should  be  kept  and  the  most 
accurate  measurements  taken  at  fixed  intervals. 
The  salt  air  at  the  seashore  for  a  short  interval  seems 
to  have  a  wonderfully  beneficial  effect  upon  these 
cases  and  it  is  well  to  stop  the  massage  occasionally 
for  a  week  or  so  for  a  trip  to  the  shore.  The  improve- 
ment will  afterward  be  so  much  more  rapid. 

The  movements  which  I  use  are  principally  for 
the  spine  as  Lying  raising  of  the  body.  At  first 
it  is  often  necessary  to  tie  a  sheet  around  the  foot- 
board of  the  bed  and  have  the  patient  try  to  pull 
himself  up  or  it  may  be  necessary  for  the  operator 
or  the  mother  who  should  be  taught  how  to  give 
these  movements,  to  assist  the  child  by  placing  the 
hand  between  the  shoulder  blades.  Suspension, 
passive  and  active  we  have  already  discussed.  Now 
in  regard  to  the  movements  for  the  extremities  used 
in  connection  with  our  massage  we  will  take  a  fairly 
typical  leg  for  demonstration:  the  foot  is  constantly 
extended,  hence  we  flex  the  foot  (much  easier  done 
if  the  leg  is  flexed  at  the  same  time)  to  overcome  the 
contraction  of  the  extensors.  The  foot  is  not  only 
extended  but  also  everted;  consequently  we  invert 
it  with  our  flexion.  The  same  child  can  draw  her 
leg  up  but  can  not  possibly  push  it  down  or  in  any 
way  extend  it,  hence  we  practise  extension  of  the 
leg;  the  right  leg  she  can  bring  in  to  the  median 
line  hence  her  adductors  of  the  right  side  are  saved, 
but  she  lacks  power  of  rotation  outward  so  we  give 
that   movement    to    act   upon    the   biceps   femoris 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     1 29 

and  the  gluteus  maximus.  The  operator  must  of 
necessity  study  out  each  individual  case  to  obtain 
good  result,  as  there  are  never  two  cases  of  polio- 
myelitis exactly  alike. 

On  account  of  the  excellent  results  that  the  author 
has  had  in  treating  this  affection,  it  has  frequently 
been  suggested  that  he  had  some  new,  secret  methods 
of  treatment,  but  such  is  not  the  case  and  any  intel- 
ligent and  qualified  operator  will  by  following  the 
above  instructions  have  the  same  good  results. 
It  should  also  be  mentioned  that  I  frequently  make 
use  of  exercises  similar  to  those  described  by  Fraenkel 
to  help  along  coordination.  On  a  board  I  draw  two 
large,  round  points  connected  with  a  line  and  make 
the  child  learn  to  follow  this;  afterwards  I  make  a 
triangle  in  the  same  way  and  later  a  semi-circle  or  an 
ellipse.  I  have  found  these  simple  exercises  of  great 
practical  value. 

TABES 

Apply  massage  of  the  back  in  connection  with 
pressing.  Massage  of  the  abdomen,  with  pressing 
above  the  bladder  and  pressing  and  shaking  of  the 
extremities,  are  frequently  used.  Some  authors 
recommend  extension  of  the  legs,  pulling  of  the  legs 
and  beating  of  the  sacrum.  The  movements  should 
be  refreshing  and  invigorating  and  great  care  should 
be  taken  not  to  overexert  the  patient. 

A  J  rest  in  bed  for  six  weeks  with  intelligently 
applied  massage  and  inunctions,  if  indicated,  have 


130    MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

given  the  most  satisfactory  results  in  the  author's 
experience,  including  some  sixty  cases. 

Of  all  movements  recommended  by  the  authors 
on  mechanotherapeutics  in  the  treatment  of  loco- 
motor ataxia  none  equals  the  pulling  of  the  legs. 
Place  the  patient  perfectly  flat  on  his  back  without 
head-rest;  grasp  with  one  hand  around  the  ankle, 
with  the  other  firmly  above  the  knee — pulling 
downward  slowly  without  jerking.  Carefully  and 
properly  applied,  this  simple  movement  will  often 
relieve  the  most  agonizing  ataxic  pains. 

As  trained  nurses  are  often  requested  by  the  at- 
tending physician  to  inunct  a  patient  with  blue 
ointment  in  this  affection,  and  as  the  author  has  seen 
several  cases  in  which  the  "  inunction "  consisted  of 
merely  placing  the  prescribed  quantity  in  the  groin 
or  axilla,  he  considers  it  proper  to  here  give  the 
correct  method  of  inunction  as  recommended  by  Dr. 
Sigmund.  The  patient  should,  if  possible,  take  a 
hot  bath  as  a  preparation.  If  that,  for  some  reason, 
.be  impossible,  it  becomes  the  operator's  duty  to  wash 
the  part  inuncted,  either  with  soap  and  warm  water 
or  with  alcohol  and  water,  to  dissolve  the  fat  in  the 
pores.  The  ointment  should  be  worked  in  with 
moderate  friction  by  the  palm  of  the  hand:  on  the 
first  day  on  the  inside  of  the  legs;  on  the  second  day 
on  the  outside  of  the  thighs;  on  the  third  day  on  the 
sides  of  the  trunk;  on  the  fourth  day  on  the  back; 
on  the  fifth  day  on  the  inside  of  the  arms;  on  the 
sixth  day  commence  a  new  series.     In  twenty  to 


MASSAGE   AND    MOVEMENTS    IN    TREATMENT     131 

thirty  minutes  the  seance  is  completed.  The  opera- 
tor should  wear  a  glove  to  protect  himself  from  ab- 
sorbing the  drug.  In  the  friction  it  is  best  to  try 
to  describe  a  figure  eight,  unless  the  parts  are  heav- 
ily covered  with  hair — then  work  in  a  circle.  If  the 
patient  desires  to  conceal  the  fact  that  he  is  taking 
the  inunction,  wash  the  parts  worked  upon  and 
remove  every  trace  of  the  proceeding.  The  best 
result  will  be  accomplished  if  the  drug  is  allowed  to 
remain  on  the  skin  to  be  gradually  absorbed.  Three 
hot  baths  a  week  are  generally  recommended. 

The  new  preparation  "Mercury-Vasogen"  is  now 
generally  used  for  inunction  and  it  is  far  superior 
to  the  blue  ointment  as  it  works  in  so  much  quicker 
and  does  not  leave  a  disagreeable  odor.  Besides 
it  has  been  the  author's  experience  that  it  does  not 
produce  any  skin-affections,  while  the  blue  ointment 
is  very  apt  to  cause  not  only  local  irritations  of  the 
parts  inuncted,  but  also  eczema  and  erythema. 

NEURALGIA 

Diseases  of  the  peripheric  nerves  are  more  success- 
fully treated  by  mechanotherapy  than  are  affections 
of  the  central  nerve-system.  Most  neuralgias  yield 
readily  to  massage,  and  in  cases  of  sciatica  it  has  been 
used  with  most  excellent  results. 

For  the  latter  disease,  if  the  right  leg  is  affected, 
use: 

1.  Stroking  of  right  leg  (from  behind). 


132     MASSAGE   AND   MOVEMENTS   IN   TREATMENT 

2.  Percussion  and  beating  over  the  nerve. 

3.  Flexion  and  extension  of  right  leg. 

4.  Raising  of  leg. 

5.  Beating  of  sacrum  and  right  leg. 


Fig.  iio. — Right  Method  of  Stroking  Radial  Nerve  Supporting 

Below. 


Some  of  the  manipulations  must  be  repeated  in  the 
series  five  or  six  times.  In  raising  the  leg,  place  it,  if 
necessary,  on  the  shoulder,  and,  bending  up  and 
down,  stretch  the  sciatic  nerve  as  much  as  possible. 

Rheumatic  neuralgia  in  other  nerves,  as  in  the 


MASSAGE   AND   MOVEMENTS    IN  TREATMENT     1 33 

trigeminus,  so  often  found  in  anemic  women,  is  often 
relieved  by  massage  in  a  few  treatments. 

Use  freely  punctation  over  superficial  nerves, 
and  firm  kneading  and  stroking  with  the  thumbs. 
If  the  nerve  is  very  tender,  begin  with  a  slight  intro- 
ductory stroking  with  the  thumb. 


Fig.  hi. — Wrong  Method  of  Stroking.     Note  Left  Hand  Support- 
ing Above  Part  Manipulated. 


In  some  cases  it  may  be  advisable  to  use  massage 
of  the  head,  as  described  in  Local  Massage. 

Massage  of  the  neck  (Hoemnger's  method)  is  an 
excellent  remedy  for  many  forms  of  neuralgia  of  the 
head  and  face. 


134    MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

NEURITIS 

Neuritis  is  an  inflammation  of  the  nerve-trunks 
with  pain,  specially  intensified  by  pressure.  Gentle 
massage  in  the  form  of  strokings  is  indicated  from  the 
beginning.  In  a  case  of  neuritis  of  the  arm  we  treat 
the  brachial  plexus  carefully  and  stroke  gently  up- 


Fig.  112. — Stroking  of  the  Brachial  Nerves. 

ward  from  the  finger-tips  to  the  spinal  column.  It  is 
best  to  have  the  arm  well  supported  in  a  sling  broad 
enough  to  fully  support  the  whole  length  of  the 
forearm. 

In  multiple  neuritis  we  have  had  most  excellent 
results   from  massage  gently  applied.     It  will  not 


MASSAGE    AND    MOVEMENTS    IN   TREATMENT     135 

do  to  treat  a  neuritis — no  matter  of  what  cause — 
with  deep  pressure  as  the  nerves  are  extremely 
tender  and  the  inflammation  will  be  inci  eased. 
The  strokings  help  because  they  relieve  the  blood 
tension  along  the  nerve-tract.  If  the  operator  only 
remembers  this  rule  of  care,  we  shall  not  hear  any 
more  complaints  that  massage  is  not  indicated  in 
the  treatment  of  neuritis. 

The  author  favored  the  use  of  "  Eucalyptus 
liniment"  from  which  he  claimed  good  results.  Rub 
the  affected  part  with 

Oil  of  Eucalyptus i  oz. 

Camphor  Petrogen  (Wyeth) 2  oz. 

[Editor] 

PROGRESSIVE  MUSCULAR  ATROPHY 

Use  massage  in  the  neighborhood  of  the  affected 
muscles  and  upon  them,  and  such  movements 
as  are  calculated  to  increase  circulation  through  the 
diseased  parts. 

Suppose  a  case  of  atrophy  in  the  deltoid  and 
supraspinatus;  the  following  treatment  should  be 
used: 

1.  Massage  of  the  arm  from  the  fingers  up  to  the 
trapezius. 

2.  Rotation  of  the  hand. 

3.  Flexion  and  extension  of  the  arm. 

4.  Rotation  of  the  shoulder. 


136     MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

5.  Firm  hacking  or  clapping  upon  the  whole 
arm,  and  especially  around  the  shoulder. 

6.  Vibrations  over  brachial  plexus. 

WRITERS'  CRAMP 

Use  massage  from  the  tips  of  the  fingers  to  the 
shoulder.  Rotation,  turning,  flexion,  and  extension 
of  the  hand  and  arm  may  be  used  as  the  patient 
grows  stronger,  but  massage  is  the  principal  part 
of  the  treatment. 

The  operator  must  be  careful  not  to  overtax 
his  patient's  strength.  In  beginning  only  treat 
the  hand  and  forearm  from  ten  to  fifteen  minutes. 
— The  prognosis  in  trade  neurosis  is  not  particularly 
good,  but  I  think  it  is  most  generally  accepted,  that 
massage  and  movements  are  the  most  effective  means, 
and  should  at  least  be  given  a  fair  trial. — [Editor.] 

SPLANCHNIC  NEURASTHENIA 

So  important  has  this  functional  disturbance 
lately  become  in  this  country  that  it  is  high  time 
that  its  proper  mechanical  treatment  be  analyzed. 
As  Dr.  Abrams  so  clearly  puts  it,  the  principal 
symptoms  are:  " Abdominal  sensitiveness,  tender- 
ness of  the  liver  and  enlargement  of  that  organ 
and  gaseous  accumulation  in  the  bowels." 

In  regard  to  the  treatment  we  have  to  remember 
that  physiologists  have  proven  to  us  the  fact  that 


MASSAGE    AND    MOVEMENTS    IN   TREATMENT     137 

the  abdominal  veins  are  very  elastic  and  that  they 
are  really  capable  of  holding  at  one  time  the  total 
blood  volume  of  the  whole  body.  In  splanchnic 
neurasthenia  we  have  first  of  all  to  overcome  the 
intense  congestion  of  blood  in  the  splanchnic  and 
abdominal  veins  in  general. 

We  begin  with  massage  of  the  liver,  so  as  to  give 
the  venous  circulation  a  free  outlet.  The  patient 
is  lying  on  his  left  side  with  the  right  arm  over  his 
head  and  the  operator  carefully  works  over  the  whole 
hepatic  region  not  forgetting  the  three  splanchnic 
nerves.  Many  "  paths  and — practics"  would  have 
you  believe  that  they  are  the  only  ones  who  pay 
proper  attention  to  organic  nerve-supply,  but  it  is 
not  true.  Fortunately  we  possess  the  plain  writing 
of  P.  H.  Ling  and  his  true  pupils  published  almost 
one  hundred  years  ago  to  conclusively  prove  that 
the  Swedish  mechanical  operator,  or  medical  gymnast 
who  is  properly  trained  always  is  taught  to  attend 
to  the  nerve- supply  of  the  individual  organ  or  muscle 
that  he  may  be  treating.  The  massage  of  the 
abdomen  in  general  is  now  given  so  as  to  improve 
the  muscular  tone  and  overcome  the  local  congestion. 
Massage  of  the  neck  is  also  given. 

As  we  gain  ground  we  instruct  the  patient  in 
some  of  those  Swedish  movements  which  com- 
press the  viscera  and  tone  up  the  whole  abdomen. 
Other  therapeutics  in  the  shape  of  electricity  and 
hot-cold  sponge  baths  are  most  effective,  and  the 
reader  who  is  specially  interested  in  the  rational 


138     MASSAGE    AND   MOVEMENTS    IN   TREATMENT 

treatment    of    the    affection,    should    procure    that 
excellent  work:  "The  Blues"  by  Dr.  Albert  Abrams. 

AFFECTIONS  OF  THE  RESPIRATORY  ORGANS 

Respiration  is  altogether  mechanical,  depending 
upon  the  constitution  of  the  muscles  of  the  chest,  the 
extension  of  the  latter,  and  the  quantity  of  air  in- 
spired. If  the  capacity  of  the  lungs  be  increased, 
all  difficulty  of  breathing,  coughs,  etc.,  caused  by 
an  imperfect  respiration,  will  soon  disappear. 

In  cases  where  defective  respiration  is  the  result 
of  weakness  of  the  respiratory  muscles  or  of  deformi- 
ties of  the  chest,  the  movements  have  proved  the  best 
means  for  increasing  the  capacity  of  the  respiratory 
organs  (see  page  96  ) . 

The  effect  of  the  medical  gymnastics  is  to  necessi- 
tate frequent  and  deep  inspirations,  and  more  com- 
plete expiration,  thus  increasing  the  capacity  of  the 
lungs,  promoting  pulmonary  circulation  and  causing 
an  increased  oxygenation  of  the  venous  blood. 

CATARRH  OF  THE  LUNGS 

Certain  manipulations  (hacking,  clapping  and 
shaking)  on  the  chest  have  been  used  to  induce 
expectoration.  The  movements  must  be  such  as  to 
cause  muscular  activity  and  increase  the  secretion 
from  the  skin.  Action  upon  the  digestive  organs  will 
produce  a  derivative  effect  upon  the  lungs. 


MASSAGE   AND    MOVEMENTS    IN   TREATMENT     1 39 

PHARYNGITIS  AND  LARYNGITIS 

Because  massage  of  the  neck  and  throat  induces 
such  an  evacuation  of  the  blood-vessels,  it  has  been 
freely  used  for  acute  catarrh  of  the  pharynx,  trachea 
and  nose.  We  are  able  by  careful  examination  of  the 
inflamed  mucous  membranes,  before  and  after  the 
application  of  massage,  to  notice  directly  the  result. 
Not  the  local  symptoms  only,  but  the  headache,  the 
pain  in  the  forehead,  the  dizziness,  etc.,  resulting 
from  the  stagnation  of  blood,  disappear  after  a  few 
treatments.  By  massage  we  also  act  upon  the  ton- 
sils and  other  glands,  thus  assisting  expectoration. 

Croup  may  sometimes  be  speedily  relieved.  Weiss 
has  noted  a  case  of  croup  in  which  a  single  application 
removed  the  most  imminent  peril. 

The  massage  of  the  neck  and  throat  ought  to  be 
more  freely  used  for  these  affections. 

CONSUMPTION 

Some  respiratory  movements  are  used  to  make  the 
patient  more  comfortable,  increasing  the  inspiration 
and  assisting  the  heart  in  its  action. 

Massage  of  the  lower  extremities  is  sometimes 
applied  to  relieve  the  swelling  and  to  increase  the 
circulation. 

General  massage  is  often  recommended  as  a  tonic, 
but  should  always  be  given  in  the  forenoon,  and 
never  at  night,  as  it  has  then  a  decided  tendency 
to  increase  the  night  sweats. 


140    MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

BRONCHITIS,  NERVOUS  ASTHMA,  ETC., 

are  frequently  treated  by  massage,  generally  in 
the  form  of  strokings  of  the  entire  chest,  the  patient 
inspiring  deeply  at  the  same  time.  The  seance  must 
not  exceed  twenty  minutes. 

COLDS 

So  many  persons  suffer  with  recurrent  colds  in  our 
changeable  climate  that  we  deem  it  well  to  pay  some 
attention  to  the  matter.  A  cold  is  an  inflammation 
of  the  mucous  membrane  lining  the  upper  respiratory 
passages.  One  region  is  generally  more  affected 
than  the  others.  A  cold  begins  with  a  congestion 
and  its  principal  causes  are:  (i)  " chilling  the  skin 
in  a  person  whose  skin  is  sensitive  and  tender  to  the 
changes  of  temperature,  causing  a  contraction  of  the 
superficial  blood-vessels,  and  driving  an  excess  of 
blood  to  the  deeper  structures  of  the  body;  (2)  local 
irritation  to  an  already  congested  respiratory  tract, 
by  the  inhalation  of  polluted  air,  and  air  containing 
irritating  substances  such  as  dust,  smoke,  gases, 
etc." 

Colds  are  most  common  in  winter  time,  not  on 
account  of  the  cold  weather  but  because  at  that 
time  we  breathe  the  most  impure  air,  everything 
often  being  shut  up  in  order  to  keep  warm. 

To  prevent  colds  we  must  consequently  breathe 
pure  air  and  keep  the  function  of  the  skin  normal. 
This  latter  is  best  accomplished  by  proper  daily 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     141 

bathing,  massage  and  exercise.  For  the  younger 
person  we  think  nothing  better  than  a  cool  sponge 
off  with  brisk  friction  every  morning  in  a  room  of  a 
temperature  never  less  than  700  F.  For  older  persons 
and  for  those  not  so  very  robust  we  recommend  the 
hot-cold  spray  bath.  The  person  sits  in  a  tub  with 
warm  water  up  to  the  hips;  now  spray  the  spine, 
neck  and  chest  with  cool  water,  starting  with  a 
temperature  of  850  F.,  and  gradually  in  the  course 
of  a  week  or  two,  lowering  it  down  to  500  F.  Half  a 
minute  is  enough  at  first.  A  strong  self-massage 
with  a  rough  rubber  sponge  or  wash  cloth  is  advis- 
able, but  the  patient  should  always  rub  himself 
perfectly  dry  with  a  rough  towel.  If  weak  this  must 
of  course  be  done  by  an  attendant. 

If  the  patient  has  the  opportunity  of  scientific 
massage  for  half  ah  hour  each  morning  so  much  the 
better;  if  not  we  must  teach  him  some  few  effective 
movements  to  be  practised  every  morning  after 
his  bath.     The  following  are  good: 

1.  Standing  rotation  of  arms. 

2.  Ostrom's  combined  resp.  movement. 

3.  St.  bending  of  the  body  forward  and  backward. 

4.  Deep  knee  bend. 

5.  St.  bending  of  the  body  sideways. 

We  do  not  wish  the  reader  to  lose  sight  of  the  fact 
that  there  are  certain  remedies  which,  if  taken  in  the 
very  incipiency  of  a  cold,  are  really  specific  in  their 
effect. 


142     MASSAGE   AND   MOVEMENTS    IN   TREATMENT 

DISEASES  OF  THE  HEART 

Massage  and  movements  are  indicated  in  affec- 
tions of  the  heart  caused  by  nervous  debility,  anemia, 
diseases  of  the  stomach,  etc.  The  movements 
mostly  used  are: 

Sitting,  raising  of  the  chest,  with  shaking,  to  produce 
strong  respiration; 

Rotation  of  the  extremities,  to  assist  the  heart  in  its 
action; 

Rotation  and  turning  of  the  body,  to  give  effect 
upon  the  great  venous  system; 

Centripetal  stroking,  to  remove  the  subcutaneous 
effusions. 

In  organic  diseases  of  the  heart,  movements  are 
recommended  by  some  of  the  most  eminent  physi- 
cians. They  apply  movements  to  support  the  heart 
in  its  action,  generally  using  such  as  will  increase 
the  circulation  in  the  distant  parts  of  the  body. 

Within  the  last  few  years  a  new  system  of  exercise 
for  heart-affections  has  been  developed  by  Dr. 
August  Schott,  of  Bad  Nauheim,  Germany.  The 
results  have  at  times  been  remarkable.  He  employs 
the  effervescent  Nauheim  water,  as  a  rule  daily,  and 
directs  a  series  of  resistive  exercises  (original  Swedish 
movements)  to  be  given  daily,  or  every  other  day 
if  the  patient  is  too  weak.  The  general  massage — 
gently  applied — is  too  often  lost  sight  of  as  a  most 
excellent  preparation  for  this  particular  movement 
cure.     All    the    movements    are    duplicated-active, 


MASSAGE   AND   MOVEMENTS    IN   TREATMENT     1 43 

and  the  resistance  should  be  so  applied  as  not  to 
interfere  with  the  circulation — preferably,  when 
possible,  with  the  palmar  surface  of  the  hand.  Every 
movement  should  be  performed  slowly,  and  the 
operator  should  watch  his  patient  most  carefully. 
At  first  the  seance  should  last  but  ten  minutes,  to 
be  gradually  and  carefully  increased  to  thirty  min- 
utes. A  rest  should  be  allowed  after  each  movement, 
and  no  exercise  is  to  be  applied  more  than  once  in  each 
series.  The  operator  should  carefully  guard  against 
the  following  symptoms: 

1 .  Intermission  of  the  pulse. 

2.  Weakness  of  the  pulse.' 

3.  Increased  respiration. 

4.  Palpitation  of  the  heart. 

5.  Dilatation  of  the  nostrils. 

6.  General  feeling  of  discomfort. 

When  any  of  the  above-mentioned  symptoms 
appear  allow  a  few  minutes'  rest;  or,  if  necessary, 
stop  the  treatment  for  the  day.  It  is  customary 
to  take  the  pulse  and  respiration  before  starting, 
during  the  middle  of  the  seance,  and  at  its  close. 
A  careful  record  should  be  kept  for  the  reference 
of  the  attending  physician. 

The  principal  Schott  exercises  are: 

1..  Separating  and  closing  of  arms. 

2.  Flexion  and  extension  of  arms. 

3.  Raising  of  the  arms  upward. 

4.  Rotation  of  the  arms. 

5.  Pronation  and  supination  of  the  forearm. 


144    MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

6.  Flexion  and  extension  of  the  hand. 

7.  Flexion  and' extension  of  the  fingers. 

8.  Abduction  and  adduction  of  the  fingers. 

9.  St.  bending  of  the  body  forward  and  backward. 

10.  S.  bending  of  the  body  sideways. 

11.  S.  rotation  of  the  body. 

12.  Same  as  1,  with  clenched  fist. 

13.  Same  as  2,  with  clenched  fist. 

14.  St.  arms  extended  forward  and  backward. 

15.  L.  flexion  and  extension  of  the  leg. 

16.  L.  flexion  and  extension  of  the  foot. 

17.  L.  separation  and  closing  of  the  thighs  or  legs. 

18.  St.  leg  extended  forward  and  backward. 
Careful    operators    are    sometimes    requested    to 

apply  treatment  locally;  then  use  massage  of  the 
chest,  as  previously  described,  with  hacking  in 
small  circles  over  the  cardiac  region.  Palmar 
vibrations  are  also  used.  In  the  European  insti- 
tutes of  medical  gymnastics  it  is  quite  common  to 
see  the  vibrations  applied  over  the  heart.  The 
operator  then  places  his  arm  upon  the  artificial 
vibrator  and  the  wave-like  movements  are  trans- 
ferred to  the  cardiac  region  through  the  semi-flexed 
and  abducted  fingers.  Except  when  especially 
requested  by  a  physician,  however,  this  local  appli- 
cation is  seldom  used.  Gentle  respiratory  move- 
ments should  always  form  the  conclusion  of  the 
treatment,  and  an  hour's  rest  should  be  rigidly  in- 
sisted upon. 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     145 
DISEASES  OF  THE  DIGESTIVE  ORGANS 

In  applying  mechanotherapy  for  these  affections, 
we  must  call  attention  to  the  fact  that  most  of  them 
develop  from  circulatory  disturbances,  the  vessels 
being  relaxed. 

There  are  different  ways  to  apply  massage  of  the 
stomach;  one  has  already  been  described.  Another 
way  is  to  place  the  ringers  about  two  inches  below 
the  ribs  and,  with  pressing,  move  the  hand  upward 
in  connection  with  shaking.  In  a  special  position 
(half  lying,  with  the  knees  flexed,  so  as  to  relax 
the  abdominal  muscles,  crook-half-lying)  it  is  quite 
easy  to  reach  the  stomach  by  pressing,  shaking  and 
kneading. 

Massage  of  the  stomach  is  indicated  in  all  affections 
caused  by  circulatory  disturbances  or  general 
weakness  (atony)  of  the  parts. 

DYSPEPSIA 

1.  Massage  of  the  stomach  and  the  abdomen 
(fifteen  minutes) . 

2.  Percussion  of  the  back. 

3.  High  St.  pulling  of  legs. 

4.  S.  turning  of  body. 

5.  Flexion  and  extension  of  legs. 

6.  S.  rotation  of  arms. 

The  movements  are  repeated. 

10, 


146     MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

HABITUAL  CONSTIPATION 

Massage  and  movements  are  now  freely  used  for 
constipation.  The  treatment  must  always  be  local 
in  the  beginning,  and  afterward  constitutional. 

1 .  Local  massage  (ten  to  twenty  minutes) . 

2.  St.  bending  of  knees  (hands  on  hips). 

3.  L.  raising  body. 

4.  S.  turning  of  body. 


.-"''' C::\/    -il\     ^ 


Fig.  113. 

5.  St.  beating  of  sacrum. 

6.  See  3. 

7.  See  4. 

8.  Flexion  and  extension  of  legs. 

9.  St.  percussion  of  back. 

Schreiber  says:  " Chronic  constipation  offers  the 
most  signal  success  to  mechanotherapy,  for  it  is 
possible  to  make  direct  mechanical  pressure  upon 


MASSAGE   AND    MOVEMENTS   IN   TREATMENT     1 47 

the  celiac  and  hypogastric  plexuses,  and  through  these 
to  reflexly  excite  peristalsis;  furthermore,  the  vaso- 
motor nerves  and  the  intestinal  muscular  fibers  are 
directly  stimulated  by  the  squeezing  to  which  they 
can  be  subjected."  The  treatment  is  indeed  very 
effective,  and  it  is  not  rare  to  obtain  an  evacuation 
of  the  bowels  immediately  after  the  manipulations. 


Fig.  114. 


After  the  patient  has  taken  a  course  of  treat- 
ment he  should  be  instructed  to  take  every  morning 
a  few  exercises  to  keep  the  bowels  working  properly. 
The  patient  will,  as  a  rule,  offer  the  common  excuse 
he  has  no  time  for  such  a  procedure,  but  the  operator 
should  rigidly  insist  upon  it,  telling  him  that  he,  by 
neglecting  to  take  the  exercises,  may  gradually  lose 
the  benefit  of  the  course  of  treatment  he  has  under- 
gone, and  incidentally,  he  may  suggest  to  his  patient 


148    MASSAGE   AND   MOVEMENTS   IN   TREATMENT 

simply  to  rise  ten  minutes  earlier  and  he  will  have 
ample  time  to  perform  the  movements.  We  have 
selected  five  of  the  most  effective  exercises  easily 
performed  in  the  bedroom. 

As  in  Fig.  113,  the  patient  should  lie  flat  on  his 
back,  without  head-rest,  with  hands  clasped  back  of 
the  head;  he  should  slowly  rise  to  a  sitting  position, 


Fig.  115. 

and,  if  able,  even  bend  forward  as  much  as  possible. 
When  first  taking  the  movement  he  will  have  some 
difficulty  in  keeping  his  feet  down;  tell  him  to  put  a 
pillow  or  quilt  on  top  of  his  feet.  By  this  exercise 
we  strongly  compress  the  abdomen,  aiding  in  fecal 
movement  mechanically,  increasing  the  general 
peristaltic  action,  and  accelerating  the  secretions 
from  the  various  glands.  The  following  four  exer- 
cises (see  Figs.  114-117)  are  very  similar  in  their 
effect,  and  they  are  so  clearly  illustrated  that  we  do 


MASSAGE   AND   MOVEMENTS   IN   TREATMENT     1 49 

not  deem  it  necessary  to  separately  describe  them. 
(The  standing  bending  of  the  body  should  be  care- 
fully done  by  patients  suffering  from  hemorrhoids.) 
Constipation  is  of  most  frequent  occurrence 
in  infancy.  Less  than  three  evacuations  a  day 
indicate  a  constipated  condition.  Place  the  child 
flat  on  its  back  in  the  bed,  or,  if  convenient,  on  the 


<*■■£  ,.<L.'  '  •' 

I     I 


Fig.   116. 


Fig.  117. 


mother's  lap;  smear  the  abdominal  wall  with  pure 
olive  oil,  and  proceed  with  the  massage  of  the  abdomen 
as  previously  described,  paying  special  attention  to 
the  various  parts  of  the  colon.  Colic,  so  frequently 
caused  by  improper  action  of  the  bowels,  is  often 
quickly  relieved  by  massage.  If  the  abdomen  is 
much  distended,  care  and  judgment  must  be  used 


150     MASSAGE    AND    MOVEMENTS   IN   TREATMENT 

so  that  too  much  pressure  is  not  applied.  Pass 
lightly  over  the  region  of  the  transverse  colon, 
and  never  use  so  much  pressure  on  any  part  as  to 
cause  pain.  Any  intelligent  mother  can  be  properly 
instructed  to  treat  her  child  for  constipation,  and 
such  knowledge  will  often  be  very  useful  not  only 
directly  at  the  time,  but  also  indirectly  afterward, 
as  it  will  often  save  the  child  from  irritating  and 
weakening  laxatives  carelessly  administered  without 
the  physician's  orders.  Even  in  cases  of  infants, 
we  must  not  lose  sight  of  the  wonderfully  strong 
tonic  effect  of  the  massage. — A  child  responds  readily 
to  manual  treatment;  more  so  than  a  grown  person, 
but  unfortunately  this  simple  and  effective  remedy 
is  seldom  resorted  to  until  other  therapeutics  have 
failed. — [Editor.] 

HEMORRHOIDS 

Closely  connected  with  the  former  disease  is 
the  accumulation  of  blood  in  the  abdominal  parts, 
called  hemorrhoids.    . 

By  the  manipulations  on  the  abdomen  we  assist 
the  intestines  in  their  action ;  by  rotation  and  turning 
of  the  body  we  control  the  great  venous  system,  and 
by  beating  over  the  sacral  region  we  increase  the 
circulation  in  the  region  of  the  rectum  relieving 
congestion  in  the  Hemorrhoidal  vein. 

The  following  movements  have  been  used  with 
success: 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     151 

i.  Massage  of  the  liver  and  the  abdomen  (ten 
to  fifteen  minutes).     See  page  21. 

2.  St.  bending  of  knees. 

3.  Separating  and  closing  of  knees. 

4.  L.  raising  of  body. 

5.  Rotation  of  legs. 

6.  Beating  of  sacrum. 

7.  Rotation  and  turning  of  body. 

Although  we  highly  recommend  the  movements 
for  this  affection,  we  must  acknowledge  that  one 
treatment  a  day  is  not  enough.  The  patient  must 
be  instructed  in  certain  calisthenics  which  give  a 
direct  effect  upon  the  great  venous  system. 

OBESITY 

Massage  and  Swedish  movements  have  been 
used  with  great  success  in  cases  of  obesity.  Muscu- 
lar exercise  decreases  the  fat  by  promoting  a  more 
perfect  oxygenation  through  the  whole  organism. 

In  connection  with  firm  massage  use  the  following 
movements : 

1.  Separating  and  closing  of  arms. 

2.  Separating  and  closing  of  legs. 

3.  L.  raising  of  body. 

4.  St.  bending  of  knees. 

5.  St.  rotation  of  arms  (active). 

6.  St.  turning  of  body. 

During  the  first  treatments  use  only  a  few  move- 
ments, gradually  getting  the  patient  used  to  them. 


152     MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

As  pathologic  changes  in  the  texture  of  the  blood- 
vessels are  rather  common  in  cases  of  obesity  the 
operator  should  use  careful  judgment  in  regard  to 
the  strength  of  the  manipulations. 

Without  proper  diet  massage  will  accomplish 
but  very  little. 

Frequently  the  masseur  will  be  asked  by  the 
patient  how  he  can  consistently  claim  that  mas- 
sage will  reduce  fat,  and  also  in  a  thin  person  produce 
fat.  When  we  desire  to  reduce  fat  we  give  firm 
massage,  especially  kneading,  which  produces  heat; 
this  causes  combustion  of  fat.  When  we  apply  the 
treatment  with  the  object  of  increasing  weight  we 
do  so  by  building  up  the  whole  system  and  particu- 
larly the  digestive  organs.  Whatever  our  aim  may 
be,  one  of  the  most  important  parts  of  the  treatment 
consists  in  teaching  the  patients  how  to  breathe 
properly. 

ENLARGEMENT  OF  THE  LIVER 

We  use  movements,  that  are  calculated  to  increase 
the  circulation  through  the  great  venous  system. 

1.  S.  rotation  of  arms. 

2.  L.  rotation  of  feet. 

3.  S.  raising  of  body. 

4.  L  rotation  of  legs. 

5.  S.  rotation  of  body. 

6.  St.  flexion  and  extension  of  feet. 

7.  Massage  of  the  liver  with  clapping. 

8.  Separating  and  closing  of  knees. 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     1 53 

9.  Vibrations  over  the  liver. 

10.  St.  percussion  of  back. 

The  movements  must  be  performed  twice  a  day, 
and   the  patient  instructed  in  certain  calisthenics. 

DIABETES 

Some  authors  report  cases  of  diabetes  success- 
fully treated  by  mechanotherapy.  Schreiber  says: 
"The  best  effects  will  ensue  when  the  greatest 
number  of  muscles  are  brought  into  play.  It  is 
necessary  to  select  such  movements  as  will  call  into 
action  equally  all  the  great  muscle-groups." 

In  Paris,  where  diabetes  is  common,  the  patients 
are  advised  to  take  very  strong  bodily  exercise. 
The  quantity  of  sugar  secreted  must  indicate  a 
deficient  oxygenation  of  the  materials  produced  by 
the  liver.  Strong  bodily  exercise,  which  increases 
oxygenation  in  all  the  membranes  of  the  body,  ought 
to  eliminate  the  abnormal  presence  of  sugar. 

The  proper  exercise  for  this  affection  is  not  yet 
well  determined.  When  the  patient  has  a  consti- 
tution strong  enough  to  bear  the  treatment,  use  the* 
following  movements : 

1.  St.  percussion  of  back. 

2.  L.  rotation  of  feet. 

3.  Separating  and  closing  of  arms. 

4.  S.  bending  of  body  backward. 

5.  Flexion  and  extension  of  legs. 

6.  Raising  of  body. 


154    MASSAGE   AND   MOVEMENTS   IN   TREATMENT 

7.  Flexion  and  extension  of  arms. 

8.  Separating  and  closing  of  knees. 

9.  Percussion  of  back. — Strong  vibrations  of  the 
region  of  the  pancreas  stimulates  that  gland  to 
increased  secretion,  the  function  of  which  is  to 
transform  sugar  into  glycogen. 


UTERINE  AFFECTIONS 

Massage  is  applied  directly  to  force  the  organs 
to  contract,  and  the  movements  to  regulate  the 
circulation  through  the  abdomen.  Atony  and  dislo- 
cations of  the  organ  are  generally  treated  by  massage; 
disturbances  in  regard  to  menstruation,  only  by 
movements. 

AMENORRHEA 

x.  S.  rotation  of  arms. 

2.  Rotation  of  feet. 

3.  S.  turning  of  body  (inspiration). 

4.  S.  rotation  of  body. 

5.  Beating  of  sacrum. 

6.  Vibrations. 

7.  Rotation  of  arms. 

8.  St.  percussion  of  back. 

Some  of  the  movements  must  be  repeated  several 
times  in  the  series,  but  when  treating  extremely 
anemic  women  great  care  should  be  taken  not  to 
give  too  many. 


MASSAGE   AND   MOVEMENTS   IN   TREATMENT     1 55 

DYSMENORRHEA 

A  great  number  of  women  suffer  severe  pain  before 
and  during  the  periods.  In  many  of  these  cases 
we  can  by  overcoming  the  local  congestion  give  the 
greatest  relief.     We  recommend: 

1.  Massage  of  the  liver. 

2.  Massage  of  the  whole  abdomen. 

3.  St.  rotation  of  arms. 

4.  L.  rotation  of  feet. 

5.  St.  rotation  of  body. 

6.  L.  rotation  of  leg. 

7.  St.  bending  of  turned  body. 

8.  L.  rotation  of  pelvis. 

This  treatment  should  be  given  to  the  patient 
at  least  two  weeks  before  the  period  is  expected, 
and  she  should  be  properly  instructed  how  to  take 
a  few  good  movements  to  prevent  the  congestion  of 
blood  in  the  abdomen. 

I  have  made  the  observation  that  women  who 
lace  tightly  are  always  the  greatest  sufferers  from 
dysmenorrhea . 

AFFECTIONS  OF  THE  BLADDER 

We  have  here  to  deal  with  two  common  conditions : 
the  retention  of  the  urine  and  the  incontinence 
of  the  urine.  Both  have  been  successfully  treated 
by  massage.  Before  starting  the  treatment  the 
bladder  should  be  emptied  naturally,  or  artificially, 
if  necessary. 


156     MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

Massage  the  whole  abdomen  first  and  then  use 
strokings,  frictions  and  vibrations  (see  page  57) 
locally. 

In  many  nervous  women  especially  at  the  climac- 
teric period  we  find  the  symptom  of  frequent  desire 
to  urinate. 

In  such  cases  massage  is  an  excellent  remedy, 
vibrations  being  especially  effective.    . 

The  bladder  should  never  be  treated  mechanically 
except  on  the  order  of  a  physician,  as  there  are  many 
conditions  in  which  massage  may  do  a  great  deal  of 
harm  instead  of  good. 

RHEUMATISM 

The  active  movements,  as  well  as  petrissage, 
hacking  and  beating  of  the  affected  parts,  are  of 
great  benefit  in  cases  of  rheumatism.  In  severe  at- 
tacks the  treatment  should  be  applied  twice  daily. 
The  patient  must  move  his  limbs  freely  instead  of 
keeping  them  inactive. 

Begin  with  general  massage  around  and  over  the 
affected  part;  continue  with  local  massage  on  the 
diseased  muscle  or  joint  and  finish  the  treatment 
with  a  few  movements  that  give  effect  upon  the 
circulation   and   respiration. 

The  operator  should  study  his  case  carefully 
and  by  passive  and  active  movements  of  the  affected 
part  try  to  localize  the  rheumatic  deposits.  How 
important  this  is  will  be  clearly  illustrated  to  the 
reader  in  the  following  case: 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     1 57 

A  gentlemen  was  sent  to  me  for  massage  for 
a  " rheumatic  shoulder;"  he  had  been  treated  for 
some  time  with  massage  applied  locally,  i.e.,  right 
over  and  close  to  the  joint.  The  result  had  been 
unsatisfactory  and  he  had  no  faith  in  the  treatment. 
The  joint  was  carefully  examined  and  was  found  all 
right.  He  could  raise  the  arm  and  he  could  rotate 
it  without  pain  or  difficulty,  but  when  I  told  him  to 
throw  the  arm  downward  and  backward,  I  then  saw 
that  his  trouble  was  located  in  the  latissimus  dorsi. 
This  muscle  was  then  carefully  treated  and  with 
very  satisfactory  result.  He  at  first  ridiculed  the 
idea  of  curing  an  affected  shoulder  by  treating  the 
lower  part  of  the  back,  but  is  today  a  very  enthu- 
siastic believer  in  scientific  massage. 

LUMBAGO 

The  patient  should  lie  on  his  stomach  with  the 
abdomen  supported  by  pillows.  The  operator 
should  perform  firm  strokings  with  both  hands 
over  the  lumbar  region,  from  the  spinal  column 
toward  the  sides.  In  many  cases  it  is  well  to  give 
massage  to  the  whole  back  and  the  glutei,  as  pre- 
viously described. 

The  treatment  must  be  given  twice  or  three 
times  daily.  It  generally  takes  from  two  to  five 
days  to  conquer  the  trouble. 

The  following  additional  movements  may  be 
used: 


158     MASSAGE   AND    MOVEMENTS   IN   TREATMENT 

i.  St.  bending  of  body. 

2.  L.  raising  of  body. 

3.  S.  bending  of  trunk. 

4.  S.  raising  of  body. 

5.  Local  vibration. 

STIFF  NECK 

This  affection  is  somewhat  similar  to  lumbago 
and  has  been  treated  with  like  success.  Begin  with 
massage  over  the  sterno-cleidomastoid  and  continue 
with  pressing  and  shaking.  A  few  (in  the  begin- 
ning passive)  movements  will  finish  the  treatment. 
Though  at  first  painful,  the  patient  will  in  a  few 
days  be  relieved  by  the  treatment: 

The  following  movements  may  be  used: 

1.  S.  or  susp.  bending  of  head. 

2.  S.  turning  of  head. 

3.  S.  rotation  of  head. 

GOUT 

Between  the  attacks  massage  is  often  prescribed, 
especially  for  podagra.  The  treatment  must  be 
given  for  general  activity  of  the  muscles. 

1.  St.  bending  of  knees. 

2.  St.  bending  backward  (back  supported). 

3.  L.  flexion  and  extension  of  legs. 

4.  S.  turning  of  body. 

5.  S.  rotation  of  arms. 

6.  Flexion  and  extension  of  feet. 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     1 59 

7.  S.  raising  of  body. 

8.  Beating  of  sacrum. 

9.  Massage  of  stomach. 

10.  St.  percussion  of  back. 

The  general  massage  is  always  of  benefit  and 
firm  friction  on  the  sole  of  the  foot  is  very  effective 
in  cases  of  podagra. 

Massage  is  of  great  value  as  a  preventative  of 
gout,  as  it  eliminates  urates  and  improves  the 
general  condition. — [Editor.] 

LATERAL  CURVATURE  OF  THE  SPINE 

There  are  few  affections  in  which  the  movement 
treatment  has  met  with  more  signal  success  than  in 
this.  The  aim  should  be  to  invigorate  and  develop 
the  weakened  and  pathologically  changed  muscles 
of  the  convex  side  so  as  to  restore  the  natural  equi- 
librium of  the  two  sides.  There  are  but  four  known 
and  acknowledged  methods  of  developing  muscles 
locally — viz.,  massage,  movements,  electricity  and 
hydropathy.  As  the  two  latter  do  not  come  within 
the  province  of  this  manual  we  shall  only  describe 
the  two  first  mentioned. 

The  main  things  to  remember  in  treating  lateral 
curvature  of  the  spine  are : 

1.  To  elongate  the  spine  by  suspension. 

2.  To  raise  the  lower  shoulder. 

3.  To  counteract  rotation  of  the  vertebrae. 

4.  Massage  to  stimulate  the  muscles. 


l6o    MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

5.  Selected  movements  in  carefully  selected  posi- 
tions. 

Massage  of  the  back  is  very  useful  in  most  all 
cases  of  scoliosis,  and  the  operator  should  pay 
special  attention  to  the  convex  side,  particularly 
in  the  early  stages  of  the  affection.  The  treatment 
should  be  applied  also  to  the  glutei — the  gluteus 
maximus  in  particular.  Pinching  is  a  very  valuable 
manipulation,  and  when  the  patient  becomes  used  to 
the  massage  apply  it  firmly,  so  as  to  reach  the  deeper 
layers  of  muscles.  In  older  cases,  it  sometimes 
becomes  necessary  to  treat  also  the  muscles  of  the 
concave  side,  which  from  disuse  have  become  atro- 
phied. When  the  primary  curve  is  high  up,  the 
cervical  region  should  be  faithfully  attended  to. 
Patient  will  often  complain  if  too  much  pressure  is 
Used  over  the  extreme  convexity  of  the  compensation 
curve — "the  abrupt  lower  bend,"  as  some  patients 
style  it. 

We  give  here  a  list  of  the  various  Swedish  move- 
ments used  in  the  treatment  of  lateral  curvature, 
and  the  operator  who  has  been  properly  trained  will 
experience  no  difficulty  in  selecting  those  which  will 
prove  the  most  beneficial  to  the  individual  case  in 
question. 

1.  St.  Bending  to  the  (Convex)  Side. — The 
patient  stands  with  hands  clasped  on  the  back 
of  the  head.  The  operator  places  one  hand  on  the 
highest  point  of  the  curvature  and  the  other  on  the 
opposite  hip,  the  patient  bending  slowly  about  ten 


MASSAGE   AND    MOVEMENTS    IN   TREATMENT     l6l 

times.     It  may   also  be  used   as   a   single   active 
movement. 

2.  St.   Bending   to   the    (Convex)   Side. — Same 
movement  as   i,  only  the  patient  places  the  arm 


Fig.  118. 


corresponding  to  the  lower  shoulder-blade  over  his 
head  as  demonstrated  in  Fig.  118,  the  other  hand  on 
hip.  Single  active  or  duplicated  active,  in  the 
latter  case  the  operator  placing  his  hands  as  in  i . 


11 


1 62     MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

3.  St.  Rotation  of  the  Arms. — The  patient  should 
stand  as  erect  as  possible  with  arms  at  sides;  he 
should  carry  his  arms  slowly  forward  and  upward, 
then  backward  and  downward.  A  very  useful  re- 
spiratory exercise,  besides  acting  strongly  upon  the 
muscles  of  the  shoulders. 

4.  S.  Separating  and  Closing  of  the  Arms. — 
Described  on  page  85.  It  acts  strongly  upon  the 
muscles  of  the  chest,  but  also  upon  those  of  the  upper 
part  of  the  back.  Kellgren  says  that  if  this  exercise 
is  performed  with  one  arm  at  a  time,  correction  of 
the  rotation  in  lateral  curvatures  of  the  spine  is 
produced. 

5.  St.  Flexion  and  Extension  of  the  Arms. — 
This  movement  is  described  on  page  82. 

6.  St.  Raising  of  the  Arms. — The  patient  is  stand- 
ing with  thighs  supported;  the  arms  are  extended 
outward  and  raised  upward  by  the  patient,  while 
the  operator  resists,  grasping  the  wrists.  If  one 
shoulder-blade  is  much  lower  than  the  other,  work 
only  with  the  arm  corresponding  to  the  lower 
shoulder-blade. 

7.  St.  Raising  of  the  Arms. — This  movement 
is  the  same  as  No.  6,  only  it  is  single  active;  that  is, 
the  patient  performs  it  himself.  He  should  raise 
his  arms  from  the  sides  to  above  his  head  with  a 
deep  inhalation,  afterward  lower  them  slowly  to 
original  position,  and  exhale  while  doing  so. 

8.  St.  Bending  of  the  Body  Forward  and  Back- 
ward.— (See  Fig.  82.)     The  patient  should  place  his 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     1 63 

hands  on  his  hips  or  clasp  them  on  the  back  of  his 
head.  Another  form  of  this  exercise  is  performed  in 
the  following  way:  The  patient  stands  with  his 
limbs  separated  and  his  arms  stretched  straight  up; 
he  should  bend  slowly  forward  until  the  tips  of  the 
fingers  touch  the  floor  (see  Fig.  &$). 

9.  L.  Extension  of  the  Back. — The  patient  is 
lying  with  legs  on  couch,  the  trunk  extending;  the 
operator  supports  the  feet;  the  patient  bends  his 
body  upward  as  far  as  possible.  This  is  a  very 
effective  movement  and  must  be  given  with  care. 
At  first  it  is  safest  to  have  some  one  to  aid  in  holding 
the  patient.  He  may  place  his  hands  on  his  hips, 
or  clasp  them  on  the  back  of  the  head;  after  he  grows 
stronger  he  may  keep  them  extended  straight  forward 
parallel  with  the  ears. 

10.  L.  on  the  Side,  Bending  the  Trunk. — The 
patient  is  lying  with  legs  on  couch  and  trunk  ex- 
tended in  side  position,  the  convex  side  up  and  the 
feet  supported.  The  bending  should  be  performed 
slowly. 

11.  S.  Raising  of  the  Eody. — The  patient  sitting 
on  a  stool  or  a  turned  chair  with  hands  on  back  of 
head,  bends  forward,  the  operator  resisting  him 
when  he  resumes  the  original  position.  The  lower 
shoulder  may  be  raised  up,  as  the  operator  has 
perfect  control  of  the  trunk  by  his  firm  grasp  of  the 
back. 

12.  St.  Raising  of  the  Body. — The  patient,  stand- 
ing with  thighs  supported  against  a  couch  or  table 


164     MASSAGE   AND    MOVEMENTS    IN   TREATMENT 

and  hands  clasped  on  the  back  of  the  head,  bends 
forward  as  far  as  possible.  The  operator,  standing 
behind  and  supporting  the  feet  with  his  turned  foot, 
places  one  hand  on  each  side  of  the  spine.  The  pa- 
tient raises  his  body  while  the  operator  resists. 
13.  L.  Raising  of  the  Body. — See  page  146. 


Fig.  119. 

14.  St.  Turning  of  the  Body. — The  patient  stands 
with  feet  closed  and  hands  back  of  head.  He  turns 
from  side  to  side  with  or  without  the  operator's 
resistance. 

15.  Raising  of  the  Arm  of  the  Convex  Side.— 
The  patient  is  standing  with  the  arm  of  the  concave 
side  flexed  over  the  head  as  in  Fig.  119.     The  arm 


MASSAGE   AND    MOVEMENTS   IN   TREATMENT     1 65 

of  the  convex  side  is  raised  from  the  side  to  the  head. 
A  weight  is  generally  used.  Careful  instructions 
in  regard  to  respiration  should  be  given. 

16.  St.  Bending  of  the  Knees;  Book  on  Head 
("Deep  Knee-Bend").  The  hands  are  placed  on 
the  hips  with  fingers  in  front;  the  patient  bends 


Fig.  120. 

slowly  downward,  counting:  (i)  raising  on  the 
tiptoes;  (2)  bending  down  as  far  as  possible;  (3) 
resuming  tiptoes  position;  (4)  back  to  original 
standing  position  (see  Fig.  120).  The  effort  of 
keeping  the  body  erect  in  balancing  makes  this  a 
very  useful  exercise  in  the  earlier  stages  of  cur-va- 


1 66     MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

tures.  The  operator  should  watch  the  patient 
carefully  to  see  that  the  proper  position  is  maintained 
from  start  to  finish. 

17.  Stretch-standing  Bending  of  the  Knees. — 
Similar  to  16,  only  the  patient  stands  with  his 
arms  stretched  upward  close  to  his  ears,  as  shown  in 

Fig.  54- 

18.  St.  Bending  of  the  Body.— The  right  (if  the 
convexity  is  on  the  right  side)  foot  forward;  right 
hand  on  hip;  left  arm  raised  up  and  left  hand  down 
the  back,  between  the  shoulder-blades;  the  patient 
should  bend  slowly  forward.  Generally  single  active, 
but  may  also  be  duplicated  active. 

19.  Kneeling  Bending  of  the  Body. — Same  exer- 
cise as  18,  only  the  patient  rests  on  the  knee  of  the 
concave  side  and  places  the  foot  of  the  convex  side 
forward.     Single  active. 

20.  Bending  Backward;  Free-standing. — "The 
patient  stands  at  a  distance  somewhat  less  than  the 
length  of  his  own  foot  from  the  wall.  He  places 
his  hands  on  his  hips  with  his  elbows  well  thrown 
back.  Then  he  stretches  himself  and  bends  back- 
ward. When  the  movement  can  not  be  continued 
any  farther,  the  patient  falls  back  until  the  back  of 
his  head  touches  the  wall  by  which  he  stands.  Then 
he  slowly  rises  up  on  his  toes,,  and  while  doing  so 
draws  a  deep  inspiration  and  goes  slowly  down 
again"  (Kellgren). 

21.  St.  Bending  of  the  Head  Forward  and  Back- 
ward.— The  patient  stands  with  his  hands  against 


MASSAGE    AND   MOVEMENTS   IN   TREATMENT     167 

the  wall  and  with  his  feet  about  twenty  inches  from 
the  wall;  the  operator  places  his  hand  on  the  back 
of  the  patient's  head  and  resists  in  the  movement. 
This  movement  is  very  effective,  and  the  author 
suggests  that  the  reader  have  it  applied  to  himself 
so  as  to  personally  feel  its  effect  upon  the  different 
muscles  of  the  back. 

22.  St.  Stretching  of  the  Vertebral  Column. — 
This  is  a  new  movement,  recommended  by  the  well- 
known  Mr.  H.  Kellgren,  of  London.  The  patient 
stands  as  straight  as  possible;  the  operator  stands  in 
front  of  him  and  places  one  hand  on  the  patient's 
head,  and  with  the  other  he  steadies  him  by  placing  it 
over  the  sternum  or  abdomen;  he  presses  firmly  down 
with  the  hand  on  the  head,  while. the  patient  is  told 
to  stretch  upward  as  far  as  possible.  Be  careful 
to  see  that  it  does  not  become  only  a  simple  raising 
of  the  shoulders.  We  want  a  stretching  of  the 
whole  spinal  column. 

23.  Susp.  Bending  of  the  Head. — The  patient 
is  suspended  a  few  inches  from  the  floor.  The 
operator,  standing  at  his  side,  places  one  hand  on  the 
forehead,  the  other  on  the  back  of  his  head.  The 
patient  moves  the  head  forward  and  backward, 
the  operator  resisting,   according  to   the  strength. 

24.  Susp.  Separating  and  Closing  of  Legs. — 
If  the  patient  is  weak,  make  the  movement  active 
at  first,  while  the  operator  supports  the  sides. 
Afterward  make  it  concentric,  the  operator  grasping 
around  the  ankles. 


1 68     MASSAGE    AND    MOVEMENTS    IN   TREATMENT 

25.  Susp.  Flexion  of  Legs  upon  the  Abdomen. — 

The  patient  is  suspended  and  flexes  his  extended 
limbs  upon  the  abdomen.  This  is  a  very  strong 
movement  and  should  be  used  only  when  the  pa- 
tient's strength  allows. 

It  is  very  important  to  watch  the  patient  in 
regard  to  his  position  for  each  movement.  A 
rest  should  be  given  after  every  exercise,  and 
it  may  be  well  to  mention  that  the  most  com- 
plete rest  is  obtained  when  the  patient  lies  flat  on 
his  abdomen  with  pillows  under  chest  and  stomach. 
Measure  the  patient's  height;  also  curvature  itself. 
This  is  best  done  by  putting  the  end  of  the  tape- 
measure  on  the  vertebra  corresponding  to  the  ex- 
treme point  of  the  convexity;  carry  it  forward  over 
the  highest  point  of  the  convexity  to  the  sternum  or 
a  fixed  point  of  the  sternum;  then  measure  the  con- 
cave side  in  the  same  manner  and  you  will  know 
from  time  to  time  how  your  patient  improves. 
Always  have  a  set  rule  to  measure  either  before 
or  after  taking  the  movements.  It  becomes  the 
operator's  absolute  duty  to  explain  to  the  patient 
the  tedious  process  of  the  treatment  and  the  patient's 
own  responsibility  in  regard  to  the  final  result. 
Exercise  should  be  taken  every  morning  and  evening 
in  the  patient's  own  home.  The  results  are  remark- 
ably good  if  proper  judgment  is  used  in  the  selection 
of  movements.  This  treatment  for  curvature  of 
the  spine  is  very  little  known  in  America,  but  if 
given   a   fair   trial,    and   the   movements   properly 


MASSAGE   AND   MOVEMENTS    IN   TREATMENT     169 

performed,    many    unfortunates    might    be    saved 
from  being  crippled  for  life. 

A  few  cases  of  Pott's  disease  have  been  treated 
by  the  author.  Massage  of  back  and  chest  with 
respiratory  movements  were  given  with  good  results. 
Of  course  it  will  be  understood  that  there  was  no 
inflammatory  process  going  on  in  the  spinal  column 
at  the  time  of  treatment.  By  the  use  of  the  pneu- 
mauxetor  the  author  fully  convinced  himself  of  the 
increased  respiratory  capacity.  The  patients  would 
invariably  express  themselves  as  feeling  more  able 
to  hold  the  head  and  thorax  erect  and  the  increased 
respiratory  power  was  always  a  great  relief  in  this 
very  trying  deformity. 

SPRAINS 

A  sprain  is  a  sudden  dislocation  with  a  quick 
replacement  of  a  joint.  By  the  bursting  of  some 
smaller  veins  and  lymphatics  there  is  quite  an  effusion 
in  and  around  the  joint ;  the  sooner  that  fluid  is  worked 
away  mechanically  the  better  for  the  patient.  It 
seems  impossible  to  comprehend  that  many  surgeons 
still  use  plaster  of  Paris  casts  in  the  treatment  of 
ordinary  sprains,  when  massage  properly  applied 
will  effect  a  cure  in  a  short  time. 

In  sprains  it  is  necessary  to  begin  with  slight, 
careful  introductory  massage,  in  the  form  of  cen- 
tripetal stroking,  the  pain  being  very  severe.  The 
strength  of  the  manipulation  must  not  be  increased 


170     MASSAGE    AND    MOVEMENTS    IN   TREATMENT 

until  most  of  the  swelling  is  gone,  and  the  operator 
must  be  very  careful  to  work  upon  every  part  in 
the  neighborhood  of  the  joint,  applying,  as  a  rule, 
stroking  only.  Then  begin  kneading  the  muscles 
and  tendons,  always  ending  with  stroking.  The 
treatment  is  greatly  assisted  by  water  applications 
at  night.  A  flannel  or  rubber  bandage  must  be 
used  to  keep  the  swelling  down.  Some  authors 
recommend  movements  from  the  beginning,  but  I 
have  found  the  best  results  from  the  massage  alone. 

In  contraction  of  the  tendo  Achillis,  turning  and 
rotation  of  the  foot,  also  flexion  and  extension, 
ought  to  be  used  after  the  fifth  treatment. 

The  weakness  of  the  joint  after  a  sprain  is  fre- 
quently relieved  by  massage,  the  operator  being  care- 
ful to  apply  properly  the  bandage  after  each 
seance. 

DISLOCATIONS 

Inasmuch  as  "a  sprain  is  a  sudden  dislocation  with 
a  quick  replacement  of  a  joint,"  a  reduced  dislocation 
is  treated  very  much  like  an  ordinary  sprain.  Pre- 
cautions must  however  be  taken  to  avoid  a  recurrence 
until  adjoining  ligaments,  bands  and  muscles  have 
gained  sufficient  strength  to  normally  hold  the 
articulation. 

For  the  first  few  days  it  is  therefore  necessary  to 
fix  the  joint  with  a  bandage,  which  must  be  removed 
daily,  when  the  joint  is  given  a  light  effleurage  and 
some  passive  movements  to  avoid  stiffness. 


MASSAGE   AND    MOVEMENTS    IN   TREATMENT     171 

In  the  course  of  a  few  days  the  bandage  can  be 
removed  altogether,  but  the  massage  treatment  must 
be  kept  up  long  after  the  pain  and  swelling  have 
subsided. 

The  initial  swelling  may  be  considerably  checked 
and  even  reduced  by  the  application  of  ice  bandages, 


Fig.   121. — Centripetal  Strokings  with  Tips  of  Fingers  in  Dis- 
located. Fractured  or  Sprained  Elbow  Joint. 

and  later  on,  hot  applications,  preceding  each  massage 
treatment,  will  add  considerably  to  its  effectiveness. 
I  want  to  take  this  opportunity  to  warn  against 
the  prevailing  practice  of  immobilization  and  fixation 
of  a  reduced  dislocation  or  a  sprained  joint.  It  is 
doubly  wrong.     First  it  prevents  a  good  blood  supply 


172     MASSAGE    AND    MOVEMENTS    IN   TREATMENT 

so  much  needed  to  repair  injury,  and  as  Dr.  Mennel 
in  his  excellent  work  on  massage  says:  "By  absolute 
rest  the  circulation  in  the  part  is  reduced  to  a  mini- 
mum and  this  is  all  the  more  pernicious  on  account 
of  the  vaso-motor  disturbance  due  to  the  injury. 


Fig.  122. — Examining  the  Mobility  of  an  Injured  Elbow  Joint. 

In  all  these  injuries  the  surrounding  muscles 
undergo  a  rapid  wasting,  due  to  a  reflex  set  up  in  the 
joint,  which  derives  its  nerve  supply  from  the  same 
sources  as  do  the  muscles,  and  by  immobilization  there 
is  nothing  done  to  counteract  this  wasting.  This 
points  out  the  importance  of  an  early  massage  and 


MASSAGE   AND   MOVEMENTS   IN  TREATMENT     1 73 

movement  treatment  of  not  only  the  joint,  but  of 
the  adjoining  muscles  as  well. — [Editor.] 

SYNOVITIS 

Massage  is  always  indicated  in  cases  of  synovitis, 
so  long  as  there  is  no  purulent  inflammation.     The 


Fig.   123. — Friction  with  the  Thumb  in  Cases  of  Synovitis  of  the 

Knee-joint. 

introductory  massage,  in  the  form  of  centripetal 
stroking,  is  to  be  used  with  great  care.  When  the 
pain  is  diminished  some  passive  movements  may  be 
applied,  as  flexion  and  extension.  If  the  joint  be 
very  sore,  as  is  usually  the  case,  work  in  its  neighbor- . 
hood  with  kneading  and  stroking. 

In  chronic  inflammation  of  the  joints  it  is  always 
necessary  to  pay  special  attention  to  atrophied 
muscles  above  and  below  the  joint.     Friction  (with 


174    MASSAGE   AND   MOVEMENTS   IN   TREATMENT 

strokings  followed)  is  the  most ,  effective  manipula- 
tion around  joints  (see  Fig.  123). 

In  ankylosis  always  apply  very  hot  water  before 
every  seance. 

Evald  Johnsen,  a  Scandinavian  masseur,  out  of 
137  cases  of  synovitis,  cured  94  perfectly,  improved 
39  and  treated  only  4  without  any  result. 

The  patient  must  not  be  kept  in  bed,  but  must  use 
his  limbs  as  much  as  possible. 

Massage  not  only  relieves  stiffness  of  the  joint, 
but  also  prevents  total  ankylosis.  The  treatment 
must  continue  not  for  weeks,  but  for  months. 

VARICOSE  VEINS 

It  is  best  to  slightly  elevate  the  affected  limb. 
Start  the  treatment  with  massage  of  the  thigh  and 
if  the  saphenous  vein  is  not  seriously  inflamed,  work 
with  centripetal  strokings  gently  up  to  the  groin. 
In  regard  to  the  local  treatment,  the  operator  should 
avoid  too  strong  pressure  directly  over  the  veins  af- 
fected, but  should  try  to  improve  the  circulation 
in  the  collateral  veins,  thereby  relieving  the  tension 
in  the  varicose  veins.  Stroking  is  the  only  safe 
manipulation  directly  over  the  vein,  and  I  always 
use  an  oil  made  of  oil  of  sweet  almonds  three  (3) 
parts  and  oil  of  eucalyptus  one  (1)  part.  This  oil 
prevents  too  strong  friction  and,  besides  being  anti- 
septic, seems  to  have  a  soothing  effect  on  the  patient. 

We  must  remember  to  use  the  various  circulatory 
movements  of  the  foot  and  leg. 


MASSAGE   AND   MOVEMENTS    IN   TREATMENT     1 75 

We  are  used  to  hear  persons  suffering  with  this 
trouble  complain  about  their  elastic  stockings  being 
so  hot  and  uncomfortable  during  warm  weather.  I 
have  used  lately  with  great  satisfaction  the  "  Bender 
Elastic  Bandage"  or  "Maximum"  bandage  of  elastic 
stockings. 

In  cases  of  subacute  phlebitis  we  use  similar  treat- 
ment as  here  described  for  varicose  veins,  except 
that  we  are  safer  in  using  more  direct  pressure  over 
the  veins. 

HERNIA 

Many  cases  of  recent  hernia  have  been  successfully 
treated  by  massage.  The  patient  is  placed  flat  on 
his  back  without  headrest,  so  as  to  relax  the  muscles 
of  the  abdomen.  We  massage  the  muscles  in  a  gen- 
eral way  at  first  and  afterwards  locally,  the  object 
being  to  so  strengthen  the  muscular  parts  around  the 
ring  that  the  normal  retentive  power  is  established. 
I  have  used  with  great  satisfaction  the  Iodine 
Vasogen  7  per  cent,  with  this  treatment. 

There  is  no  use  of  trying  manual  treatment  for 
this  trouble  unless  the  patient  can  be  made  to  fully 
understand  that  he  is  not  to  stand  up  without  his 
truss  on.    . 

In  a  severe  case  a  surgical  operation  is  of  course 
necessary  for  a  complete  cure.  The  patient  should 
be  instructed  in  the  useful  hernia-movements  recom- 
mended by  Dr.   George  H.  Taylor,  of  New  York. 


176     MASSAGE    AND    MOVEMENTS    IN   TREATMENT 

FRACTURES 

Since  the  ambulatory  treatment  of  fractures  has 
been  described  by  Krause  in  Germany  and  by  Hood 
and  Sir  William  Bennett,  of  England,  the  American 
surgeons  seem  to  begin  to  take  to  it  more  in  a  few 
selected  cases. 

Every  simple  fracture  of  the  extremities  should 
be  treated  by  massage  before  being  reduced;  we  can, 
by  gentle  manipulations  above  and  around  the  frac- 
ture, draw  the  effusions  away.  The  nearer  a  joint 
the  fracture,  the  more  important  the  massage 
becomes.  The  operator  should  of  course  be  very 
careful  in  handling  the  injured  member  and  it  is 
necessary  to  have  someone  to  assist  in  supporting  it. 

In  fracture  of  the  patella  we  must  take  special 
care  of  the  quadriceps  extensor  femoris  and  we  must 
prevent  adhesions  of  the  fragments  above  and 
below.  In  giving  the  massage  around  the  knee 
we  hold  the  fragments  together  with  the  thumb  and 
index  finger  of  one  hand  and  work  with  the  other 
hand. 

In  severe  fractures  with  complications  treated 
by  the  old  method  the  masseur  is  often  called  upon 
to  deal  with  some  difficult  conditions.  Where  there 
is  impaired  motion  from  faulty  nerve  or  muscle 
action  the  operator  should  carefully  find  out  which 
muscles  are  the  weaker  and  massage  them;  he  should 
also  overcome  contractions  of  the  antagonists  by 
movements  or  splints  even,  if  necessary. 


MASSAGE   AND   MOVEMENTS   IN   TREATMENT     1 77 

Strokings  of  the  inside  of  the  whole  extremity 
affected  are  necessary  to  restore  the  circulation. 
Anyone  interested  in  the  treatment  of  fractures 
should  read  the  two  following  books:  "Massage  in 


\ 


« 1 


\ 


I 


Fig.  124. — Forcing  a  Stiff  Elbow-joint. 


Recent  Fractures,"   by  Sir  William  Bennett,   and 

"The  Treatment  of  Injuries,"  by  Dr.  Wharton  P. 

Hood. 

The  active  movements  are  sometimes  indicated. 

In  Figs.   124  and  125  we  have  represented  two 
12 


178     MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

different  ways  of  forcing  contracted  limbs  and  stiff 
joints.  The  practical  operator  will  see  at  a  glance 
the  great  benefit  obtained  from  the  positions  given. 

DEFORMITIES  OF  THE  FEET 

In  cases  of  club-foot  use  massage  on  the  foot  and 
on  the  leg  up  to  the  knee.  A  few  turnings  and  flex- 
ions are  very  beneficial. 

In  cases  of  " pigeon- toes"  use  similar  treatment 
as  for  club-foot,  but  with  the  massage  extended. up 
to  the  hip. 

Also  the  following  movements: 

1.  St.  turning  of  the  leg  outward. 

2.  St.  rotation  of  ext.  leg  (semicircle). 

3.  L.  separating  and  closing  of  knees. 

4.  Feet  at  more  than  right  angle,  deep  knee-bend, 
operator  supporting  chest  and  back. 

5.  Depression  and  elevation  of  legs,  the  operator 
turning  the  feet  out  as  much  as  possible. 

6.  L.  separating  and  closing  of  legs,  feet  turned 
out  as  much  as  possible. 

In  cases  of  flat  foot  we  can,  by  the  Gefvert  splint 
and  our  massage  and  movements,  cure  the  deformity 
in  a  comparatively  short  time,  if  the  patient  will  only 
persevere  and  be  willing  to  stand  a  little  pain. 
Apply  careful  massage  to  the  whole  foot  and  leg 
up  to  the  knee.  The  following  movements  are  very 
effective: 

1.  Turning  of  the  foot  inward. 


MASSAGE   AND   MOVEMENTS   IN   TREATMENT     1 79 

2.  Rotation  of  the  foot. 

3.  Flexion  and  extension  of  the  foot. 

4.  Walking  on  tiptoe. 

5.  Walking   on   the   outside   border   of   the  foot. 

6.  Feet  closed;  deep  knee-bend. 

Try  to  teach  the  patient  to  practice  walking  on 
his  tiptoes  five  or  six  times  daily.  Massage  is  a 
valuable  remedy  in  the  complicated  local  nerve- 
troubles,  so  frequently  caused  by  a  condition  of 
talipes  valgus. 


Fig.   125. — Forcing    a    Knee-joint. 

In  other  deformities  of  the  feet  the  aim  of  the 
treatment  must  be  to  work  the  affected  part  back 
to  its  proper  position  by  turning,  rotation,  flexion 
and  extension,  etc.  Local  massage  is  used  to  in- 
vigorate the  muscles  and  to  relax  contracted -tendons. 

All  the  deformities  arising  from  infantile  paralysis 
have  been  successfully  treated  by  massage. 

In  talipes  calcaneus,  where  the  heel  only  touches 
the  floor,  we  massage  the  posterior  part  of  the  leg 


180    MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

to  strengthen  the  soleus  and  gastrocnemius.  We 
extend  the  foot  by  movements  so  as  to  overcome  the 
contraction  of  the  stronger  flexor  muscles.  (See 
rules  for  treating  paralysis  on  page  124.) 

In  talipes  equino-varus  where  the  toes  come  to  the 
floor  and  the  heel  is  drawn  up  and  the  foot  inverted 
we  massage  the  tibialis  anticus,  peroneus  tertius  and 
peroneus  longus  principally.  We  flex,  evert  and 
abduct  the  foot. 

In  talipes  equino -valgus  where  the  toes  touch  the 
floor  and  the  heel  is  drawn  up  and  the  foot  is  everted, 
we  treat  the  tibialis  anticus  and  the  peroneus  tertius 
principally.  Our  movements  should  be  selected 
so  as  to  adduct  and  invert  the  foot.  When  you  have 
reached  the  safe  limit  of  a  movement  hold  the  foot 
in  that  extreme  position  for  some  time  to  overcome 
tendinous  contraction. 

With  a  good  brace  and  suitable  massage  there  is 
rarely  any  real  need  for  operating  on  the  tendo 
Achillis. 

AFFECTIONS  OF  THE  EYE 

Ocular  massage  is  being  used  more  every  day;  we 
use  the  second  finger  mostly  but  also  instruments 
like  corneal  spoon,  glass  rod,  etc.  We  press  either 
on  the  lid  to  act  upon  the  lid  itself  or  to  act  upon 
the  ball  by  firmer  pressure.  See  Fig.  25.  Massage 
of  the  lid  is  used  mostly  to  absorb  extravasations 
in  black-eye.  The  Scandinavian  oculists  employ 
ocular  massage  freely  to  hasten  the  complete  matura- 


MASSAGE   AND  MOVEMENTS   IN  TREATMENT     l8l 

tion  of  an  unripe  cataract.  The  Russian  Maklakow 
has  invented  an  electric  vibrator  in  which  percussion 
is  given  by  a  small  hammer  striking  the  ball  regularly 
several  thousand  times  a  minute. 

Massage  is  used  for  several  chronic  inflammations 
of  the  eye.  By  local  massage  we  increase  the  circu- 
lation around  the  eye,  and  act  directly  upon  the 
cornea.  When  we  desire  to  see  more  clearly  we 
rub  the  eyes,  instinct  telling  us  to  remove  from  the 
cornea  such  particles  as  are  stagnated.  Certain 
swellings  of  the  eyelids  have  been  treated  with  great 
success  by  massage  in  the  clinics  of  Schmidt,  Rimpler, 
Rossander  and  Pagenstecher. 

Cases  of  macules  cornea  (granules  on  the  cornea) 
have  been  very  successfully  treated.  In  some  cases 
it  is  wise  to  apply  massage  on  the  whole  front  part 
of  the  affected  side,  and  also  on  the  same  side  of 
the  neck. 

General  massage  is  frequently  used  to  strengthen 
the  nervous  system,  thus  giving  effect  upon  the  optic 
nerve. 

Manual  treatment  must  never  be  applied  to  the 
eye  without  an  order  from  a  physician.. 

AFFECTIONS  OF  THE  EAR 

Some  authors  (Politzer,  Eitelberg)  recommend 
massage  for  certain  affections  of  the  ear,  and  in  my 
practice  I  have  often  been  able  to  relieve  severe  pain, 
in  cases  of  otitis,  by  massage  only,  in  the  form  of 


1 82     MASSAGE   AND   MOVEMENTS   IN  TREATMENT 

centripetal  strokings  over  the  mastoid  process  and 
the  corresponding  side  of  the  neck,  as  recommended 
by  Gerst. 

In  a  few  cases  local  massage  has  been  applied  to 
the  ear  with  good  results  (Meyer  and  Lautenbach). 
As  in  chronic  congestive  headaches,  (seepage  121), 
massage  of  the  liver  and  the  cervical  and  dorsal 
nerves  is  of  greatest  benefit  in  many  ear-conditions. 
In  a  case  of  catarrhal  deafness  of  long  standing  the 
author  has  clearly  demonstrated  that  perfect  hearing 
was  restored  for  several  hours  after  each  treatment. 
Suspending  bending  of  the  head,  concentric  is  also 
of  great  help,  relieving  as  it  does  the  congestion  of 
the  many  vessels  of  the  neck.  Bending  rotation 
and  turning  of  the  head  are  also  useful  movements. 


GENERAL  REMARKS 


I.  It  is  rather  difficult  to  fix  the  time  for  a  mas- 
sage treatment.  Dr.  Mezger  works  only  a  few 
minutes  (five  to  twelve  minutes),  but  I  am  satisfied 
that  he  accomplishes  more  in  that  time  than  many 
do  in  half  an  hour.  As  a  rule,  use  shorter  time  for  a 
local  than  for  a  constitutional  affection. 

In  the  rest-cure  some  eminent  physicians  begin 
with  fifteen  to  twenty  minutes,  gradually  increasing 
the  time  to  an  hour  or  even  longer. 

II.  The  weakest  person  may  be  treated  by  mas- 
sage, since  it  is  a  remedy  so  easily  adapted  to  circum- 
stances and  so  perfectly  controlled. 

III.  The  patient  ought  not  feel  any  severe  pain 
or  disagreeable  fatigue  after  the  treatment.  Should 
such  be  the  effect,  stop  the  treatment  for  a  few  days, 
and  on  resuming  it  regulate  the  pressure  carefully. 

IV.  After  each  treatment  the  patient  should 
rest  for  at  least  half  an  hour  in  a  comfortable  position. 

V.  The  patient  should  be  urged  to  refrain  from 
excessive  eating  and  drinking,  and  the  treatment 
should  not  be  applied  within  two  hours  after  meals. 

VI.  The  operator  must  breathe  freely  while 
giving  the  treatment,  and  must  be  in  a  proper  posi- 
tion, neither  too  close  to  the  patient  nor  too 
far  off. 

183 


184  GENERAL   REMARKS 

VII.  The  temperature  of  the  room  should  be 
7°0_75°  F.;  the  operator  should  always  be  careful 
to  cover  up  the  part  massaged  and  avoid  having  any 
draft  from  windows  or  doors. 

VIII.  The  operator  should  possess  good  health 
and  muscular  strength.  He  should  be  cheerful 
and  of  refined  habits,  and  should  have  a  fair  educa- 
tion, with  a  perfect  knowledge  of  the  principal  facts 
in  anatomy  and  physiology. 

IX.  Massage  treatment  is  an  art  which  can  not 
be  self-acquired,  but  must  be  taught  by  an  experienced 
instructor. 

X.  The  manual  treatment  of  disease  ought  to 
be  regulated  by  the  medical  profession;  hence  the 
physician's  order  should  be  properly  carried  out, 
even  though  the  operator  be  of  a  different  opinion. 

XL  A  student  of  massage  should  have  the  treat- 
ment applied  to  his  own  body,  by  that  ascertaining 
the  proper  pressure  to  be  used  upon  the  various 
tissues. 


THE  MASSAGE  TREATMENT  IN 
AMERICA 


There  is  no  medical  agency  that  has  been  so 
much  abused  as  massage.  When  I  came  to  America 
I  was  anxious  to  find  out  how  the  manual  treatment 
of  disease  was  carried  on  here.  I  soon  learned  that 
there  were  no  laws  requiring  registration,  but  that 
I  could  find  the  masseurs  through  the  physicians 
and  the  daily  papers.  I  visited  several  of  these,  and 
submitted  myself  to  treatment  by  some.  L  dis- 
covered there  was  no  science  whatever  in  their 
treatment;  some  seemed  to  entirely  ignore  the  fact 
that  nature  had  provided  me  with  sensitive  nerves. 
Most  of  these  operators  used  no  oil,  and  consequently 
the  hair  bulbs  of  the  limbs  operated  on  by  them  be- 
came inflamed.  I  do  not  know  where  they  had 
acquired  their  knowledge  of  massage,  or,  as  they 
termed  it,  "the  rubbing."  One  of  them  was  sure 
that  he  had  an  inherited  power  of  magnetism,  etc., 
because  his  father  had  been  "a  prominent  rubber" 
in  Germany.  Another,  I  understood,  had  been 
working  in  a  hospital,  and  while  the  buildings  were 
undergoing  repair  he  was  offered  a  position  in  the 
basement, — whether  to  wash  dishes  or  not,  I  could 
not  find  out, — but  he  declined,  and  left  the  place 
to  become  "a  rubber,"  and  is  rubbing  still,  [j 

185 


1 86         THE   MASSAGE   TREATMENT   IN   AMERICA 

Not  only  is  the  massage  treatment  practised  by 
such  persons  whose  muscular  power  should  be  exerted 
on  something  less  sensitive  than  the  diseased  and 
weakened  human  body,  but  it  has  also  been  used  as  a 
disguise  for  vicious  purposes. 

It  is  reported  that  the  police  in  Chicago  have 
raided  a  number  of  "  massage  shops,"  and  one  of 
the  leading  daily  papers  of  Philadelphia  asserted 
that  a  raid  had  been  made  upon  similar  houses  in 
this  city,  where  the  massage  treatment  was  used  as 
a  cloak  for  vice. 

So  long  as  there  is  an  abundant  supply  of  both 
masseurs  and  masseuses,  there  is  no  necessity  that  a 
woman  should  be  treated  by  a  man,  or  a  man  by  a 
woman.  There  are,  of  course,  exceptions,  as,  for 
instance,  that  of  a  trained  scientific  masseur  or  of  a 
trained  female  nurse  who  is  attending  a  patient  in  his 
family. 

I  see  no  reason  why  such  a  powerful,  remedial 
agency  as  massage  should  not  be  fully  controlled 
by  the  medical  profession,  as  it  is  in  Europe. 

It  seems  to  me  that  the  physician  who  recommends 
an  incompetent  person  to  attend  his  patients  does 
wrong,  and  we  have  frequently  heard  sad  experiences 
from  patients  whose  social  standing  ought  to  have 
protected  them  from  being  imposed  upon  by  incom- 
petent, uneducated  persons. 

Some  time  ago  there  was  a  masseur  in  this  city 
who  was  given  a  case  of  sprain  at  the  ankle-joint. 
The  surgeon  performed  a  very  slight  flexion  of  the 


THE   MASSAGE    TREATMENT   IN   AMERICA         1 87 

foot,  so  as  to  ascertain  the  amount  of  contraction  in 
the  tissues  around  the  joint.  At  one  of  the  first 
seances  this  masseur  thought  he  would  repeat  the 
flexion  and  a  fracture  was  the  result. 

Such  things  are  unpleasant  to  bring  before  the 
public,  but  it  is  quite  proper  they  should  be  noticed 
in  a  text-book  on  massage,  when  there  is  danger  that 
one  of  the  most  natural  and  powerful  medical  agen- 
cies will  be  neglected  because  it  has  not  been  duly 
protected,  but  practised  by  persons  who  would  be 
more  appropriately  employed  at  the  wash-tub  or  in 
the  kitchen. 

Let  me  now  say  a  few  words  about  educated 
practitioners  of  the  manual  treatment.  Some  of 
them,  and  especially  females,  have  been  accused  of 
thinking  too  much  of  themselves,  of  being  too  in- 
dependent. Masseurs  and  masseuses  should  remem- 
ber that  they  are  only  using  one  special  remedy 
that  nature  has  taught  man  to  employ  to  arrest 
disease.  Persons  who  are  properly  trained  will  not 
attempt  to  enter  into  competition  with  medical 
doctors,  but  confine  themselves  to  the.  scientific 
treatment  that  we  have  endeavored  to  analyze 
in  this  little  text-book. 

Were  it  not  for*  abuses  that  have  prevailed,  the 
manual  treatment  of  disease  would  no  doubt  be  more 
universally  adopted  and  recommended  by  the  med- 
ical profession  and  the  general  public. 

From  this  short  sketch  we  conclude: 

1.  That  the  massage  and  movement  treatments 


1 88        THE   MASSAGE    TREATMENT   IN   AMERICA 

should  be  applied  only  by  educated  and  properly 
trained  persons,  with  due  regard  to  the  physician's 
directions. 

2.  That  the  operator  (if  not  a  medical  doctor) 
should  be  of  the  same  sex  as  the  patient,  with  only 
the  two  exceptions  before  mentioned. 

3.  That  there  should  be  a  place  where  skilful  and 
trained  operators  could  have  an  opportunity  for 
passing  an  examination  and  for  registering,  thus 
protecting  not  only  themselves  and  the  profession, 
but  the  general  public  as  well. 


BIBLIOGRAPHY 


For  the  convenience  of  those  who  desire  to  study 
especially  certain  branches  of  mechanotherapeutics  I 
herewith  give  a  list  of  some  of  the  English  literature 
on  the  subject. 

Abrams,  Albert. — "The  Blues."     "Spondylo-Therapy." 
Althaus,  J. — "The  Risks  of  Massage,"  "British  Medical  Jour 

nal,"  London,  1883.     I.  1223. 
Bacot,  J. — "Observations  on  the  Use  and  Abuse  of    Friction," 

etc.    London,  1888. 
Baynes,  Donald. — "Auxiliary  Methods  of  Cure:  Massage."    etc. 

London,  1888. 
Bennett,  Sir  William. — "Massage  in  Recent  Fractures."    London, 

1903. 
Block,  S—  "Massage."     New  York,  1885. 

Bloom,  Homer  C. — "  A  Clinical  Study  in  Pelvic  Massage."     "Jour- 
nal Am.  Med.  Asso.,"  April  30,  1898. 
Blundell,   J.   W.   F. — "Cases   of   Neuralgia,    Rheumatism,    etc., 

Successfully  Treated  by  Swedish  Movements."    London, 

1856. 
Bullock. — "Massage  in  the  Treatment  of   Disease."     "Louisville 

Medical  News,"  1885.     XX,  401-403. 
Butler,  J. — "Electro-Massage."     Philadelphia,  1881. 
Comstock,    A. — "Massage    Therapy."     "Therapeutic    Gazette," 

Detroit,  1888.     IV,  602-605. 
Dowse,  Thomas  Stretch.— "  The  Modern  Treatment  of  Disease 

by  Massage."     (Lectures.)     London,  1887. 
"The    Treatment    of    Disease    by    Physical    Methods."     New 

York,  1899. 

189 


190  .  BIBLIOGRAPHY 

Eccles,  A.  S—  "The  Practice  of  Massage."     New  York,   1898. 
"Massage     in     Dyspepsia     and    in     Sleeplessness."     "British 
Medical  Journal,"  London,  1887.     II,  502-504. 

Ellison,  M.  A. — "A  Manual  for  Students  of  Massage."  London, 
1898. 

Franks,  K. — "Reports  on  Massage."  "Dublin  Journal  of  Medical 
Science,"  1889.    LXXXVIII,  241-250. 

Garry,  T.  G. — "Massage  as  a  Curative  Agent."  "Lancet," 
London,  1888.     I,  921. 

Graf strom,  Axel. — "A  Text-book  of  Mechano-Therapy."  Phila- 
delphia, 1899. 

Graham,   Douglass. — "Massage."     "Medical   and    Surgical    Re- 
porter," Philadelphia,  1874.     XXXI,  181-188. 
"Massage  in  Amenorrhea  and  Dysmenorrhea,"  "Boston  Medical 

and  Surgical  Journal,"  1876.     XCIV,  146-150. 
"The  History  of  Massage."     "Medical  Record,"  New  York, 

1879.     XVI,  147-171. 
"A  Practical  Treatise  on  Massage."     New  York,  1884. 

Grant,  D. — "On  Massage."  "Edinburgh  Medical  Journal," 
i887-'88.     XXXIII,  35-39,  1 19-124. 

Granville,  I.  M. — "Nerve  Vibration  as  a  Therapeutic  Agent." 
"Lancet,"  London,  1882.     I,  949-951. 

Hood,  Wharton  P. — "Treatment  of  Injuries."    London,  1903. 

Jackson,  A.  Reeves. — "Uterine  Massage  as  a  Means  of  Treating 
Certain  Forms  of  the  Enlargement  of  the  Womb."  "  Boston 
Medical  and  Surgical  Journal,"  1880.     CHI,  388-391. 

Jones,  H.  M. — "The  Use  and  Abuse  of  Massage  in  Gynecological 
Practice."  "British  Gynecological  Journal,"  London, 
1889-90.     V,  89-105. 

Keen,  W.  W. — "Passive  Exercise  on  the  Production  of  Albu- 
minuria." "Medical  and  Surgical  Reporter,"  Philadelphia, 
1885.     LIII,  333. 

Kellgren,  Arvid. — "Technic  of  Manual  Treatment."  Edinburgh, 
1890. 

Kellogg,  J.  H—  "The  Art  of  Massage."     Battle  Creek,  Michigan, 

1895. 
Eileen,  Emil. — "Handbook  of  Massage."     Philadelphia,  1892. 
Little,  J.  F.— "Medical  Rubbing."     "British  Medical  Journal," 

London,  1882.     II,  351. 


BIBLIOGRAPHY  191 

Martin,  F.  H. — "Massage:  its  Application."  "Chicago  Med- 
ical Journal  and  Examiner,"  1883.     XL VII,  26-34. 

Mennell,  James  B. — "Massage,  Its  Principles  and  Practice." 
Philadelphia  and  London,  1.9 17. 

Mills,  Charles  K. — "Proper  and  Improper  Methods  of  Perform- 
ing Massage."  "Polyclinic,"  Philadelphia,  i886-'87.  IX, 
111-116. 

Murrell,  W. — "Massage  as  a  Mode  of  Treatment."  Phila- 
delphia, 1890. 

Muller,  George. — "Spinal  Curvature,"  etc.    London,  1904. 

Nissen,  H. — "Manual  for  Instruction  in  Giving  Massage  and 
Swedish  Movements."     Philadelphia,  1889. 

Ostrom,  Kurre  W. — "Massage  in  the  Treatment  of  Sprains." 
"Medical  and  Surgical  Reporter,"  Philadelphia,  January 
4,  1890. 

Palmer,  Marg.  D. — "Lessons  on  Massage,"  London,  1901. 

Posse,  Baron  Nils. — "The  Therapeutic  Applications  of  Medical 
Gymnastics."     "Boston    Medical   and    Surgical   Journal," 
1889.     CXX,  459-462. 
"School-Gymnastics,"  Boston,  1891. 

Post,  Sarah  E. — "Massage  Primer."     New  York,  1891.  . 

Reibmayer,  Albert. — (Translated  by  Dr.  B.  Lee.) — "Tracts  on 
Massage."     I,  II,  III.     Philadelphia,  1885. 

Ryley,  I.  B. — "Remarkable  Effects  of  Massage  on  Gastric  Assimi- 
lation and  Nervous  Debility."  "Lancet,"  London,  1883. 
I,  946. 

Smith,  A.  J. — "On  the  Treatment  of  Prolapse  of  the  Uterus  by 
Massage  and  Pelvic  Gymnastics."  "Medical  Press  and 
Circular,"  London,  1888.     N.  S.,  XL VII,  560-562. 

Smith,  A.  J. — "A  Brief  Outline  of  Dr.  Zander's  Institution  in 
Stockholm."     "Lancet,"  London,  1 881.     1,860-862. 

Snell,  S. — "On  .Massage  in  Certain  Eye  Affections."  "Oph- 
thalmological  Review,"  London,  1888.     VII,  134-139. 

Soderberg,  John. — "Swedish  Manual  Treatment."  London, 
1898. 

Sturge,  W.  K—  "Klemm  on  Muscle  Beating."  "London  Medical 
Recorder,"  1878.     VI,  290. 

Taylor,  C.  F.— "The  Movement  Cure,  with   Cases."     New  York, 


192  BIBLIOGRAPHY 

Tibbits,  Herbert. — "Massage  and  its  Application."    London,  1887. 
White,  W.  A. — "On  Massage  and  the  Weir  Mitchell  Treatment." 

"Guy's  Hospital  Report,"  London,   1888.     3d  S.,  XXX, 

267-286. 
Wide,    Anders. — "Handbook    of    Medical    Gymnastics."    New 

York,  1899. 
Williams,  Edward. — "The  Revived.     Ancient  Art  of    Massage," 

etc.     London,  1888. 
Von  Noorden,  Carl. — "Obesity."     New  York,  1903. 

"The   Technique  of  Reduction  Cures,"  New  York,  1904. 
Zeigenspeck,  Rob. — "Massage  Treatment  in  Diseases  of  Women." 

Translated  by  Westerschulte.     Chicago,    i8q8. 


INDEX 


Active  movements,  76 

Aim  of  manual  treatment,  7 

Amenorrhea,  154 

Anemia,  117 

Ankylosis,  174 

Apoplexy,  124 

Application    of    treatment    to 

diseases,  116 
Asthma,  140 
Ataxic  pains,  130 
Atony  of  muscles,  116 
of  intestines,  149 

Beating,  19 

Bending,  86 

Bibliography,  189 

Blache,  119 

Bladder,  vibrations  of,  57 

diseases  of,  155 
Bronchitis,  140 

Calisthenics,  4 
Catarrh  of  lungs,  138 
Chorea,  119 
Clapping,  18,  29 
Colds,  140 
Colic  in  infants,  149 
Combustion,  107,  152 
Concentric  movements,  76 
Constipation,  146 

home  exercises  for,  147 

in  infancy,  149 

13  193 


Consumption,  139 
Contraindications  for  massage, 

61 
Croup,  139 
Curvature  of  the  spine,  159 

Deformities  of  the  feet,  178 
Depression  and  elevation,  104 
Derivative  positions,  67 
Derivatives,  114 
Details  of  treatment,  60 
Diabetes,  153 
Diarrhoea,  34 
Dislocations,  170 
Division  of  movements,  76 
Duplicated  active  movements, 

77 
Dysmenorrhea,  155 
Dyspepsia,  145 

Ear,  affections  of,  181 
Effleurage,  9 
Eitelberg,  181 
Estimation  of  exercise,  6 
Excentric  movements,  76 
Exercise  in  therapeutics,  4 

effect  upon  the  nerves,  116 
Eye,  affections  of,  180 

Fat,  the  use  of,  in  massage,  60 
Flat-foot,  178 


194 


INDEX 


Flexion  and  extension,  81 

the  aim  of,  85 
Fractures,  176 

of  the  patella,  176 
Friction  with  the  hand,  14 

the  thumb,  14 

the  tips  of  the  fingers,  14 
Frictions,  13 

the  aim  of,  15 

Gefvert's  flat-foot  splint,  178 
General  massage,  21 

remarks,  183 

weakness,  117 
Gerst's  massage  of  the  neck,  45 
Gout,  158 

Hacking,  18 

Hartelius,    118 

Headaches,  121 

Heart,  diseases  of  the,  142 
exercises  for,  142 
local  treatment  of,  144 

Hemorrhages,  62 

Hemorrhoids,  150 

Hernia,  175 

History  of  treatment,  1 

Hoeffinger,  46 

Hysteria,  119 

Infantile  paralysis,  126 
Insomnia,  120 
Introduction,  1 
Introductory  massage,  20 
Inunction  of  mercury,  129 

Johnsen,  Evald,  174 


Kellgren,  167 

Kneading,  15 

the  aim  of,  18 
with  both  hands,  17 
with   the   thumb   and   fin- 
gers, 16 
with  the  thumbs,  16 

Kneeling,  64 

Laryngitis,  139 

Lautenbach,  182 

Lead- poisoning,  125 

Ling,  P.  H,  3 

Liver,  enlargement  of,  152 

vibration  of,  56 
Local  massage,  22 
Locomotor  ataxia,  129 
Lumbago,  157 
Lying  position,  64 

Maculae,  cornae,  181 
Massage,  8 

after  operations,  62 

as  a  tonic,  139 

definition  of,  8 

details  of,  60 

in  America,  185 

in  therapeutics,  20 

of  abdomen,  30 

of  arm,  24 

of  back,  27 

of  chest,  25 

of  eye,  43 

of  face,  39 

of  glutei,  29 

of  head,  36 

of  leg  22 

of  liver,  35 

of  neck,  45 


INDEX 


195 


Massage  of  nose,  47 

of  ovaries,  49 

of  prostate,  53 

of  spleen,  35 

of  throat,  44 

of  uterus,  51 

of  ventricle,  35 

rest  after,  183 

salve,  60 
Mechanical    actions    of    mus- 
cles, 112 
Menstruation,  62 
Meyer,  182 
Mezger,  9 

Nauheim,  142 
Neuralgia,  131 

rheumatic,  132 
Neuritis,  134 
Norstrom,  121 

Obesity,  151 

Oil  in  massage,  60 

Otitis,  181 

Ovaries,  massage  of,  49 

Padotribes,  2 

Paralysis,  124 

Passive  movements,  76 

Patella,  fracture  of,  1 76 

Percussion,  18 

Petrissage,  15 

Pharyngitis,  139 

Physiology        of        movement 

treatment,  107 
Pinching,  16,  27 
Plethora,  120 
Podagra,  158 
Politser,  181 


Positions,  63 

Potts'  disease,  169 

Pregnancy,  62 

Prescriptions  of  movements,  116 

Pressing,  54 

Pressure  in  massage,  60 

Progressive    muscular  atrophy, 

135 
Pulling,  98 
Punctation,  19 

Raising,  93 

Respiratory  movements..  96 
Rheumatism,  156 
Rossander,  181 
Rotation,  77 

the  aim  of,  80 
Round  shoulders,  75 

Scarlatina,  62 

Schmidt,  181 

Schreiber,  146 

Sciatica,  131 

Separating  and  closing,  85 

Shaking,  54 

the  aim  of,  59 

Shott,  August,  Dr.,  142 

Sigmund,  130 

Sitting  position,  64 

Skin-food,  41 

Sleeping  movements,  120 

Splanchnic  neurasthenia,  136 

Sprains,  169 

Squeezing,  17 

Standing  positions,  64 

Stiff  neck,  158 

Stroking,  9 

the  aim  of,  13 
with  both  hands,  10 


196 


INDEX 


Stroking  with  one  hand,  9 

with  the  fingers,  1 1 

with  the  thumb,  10 
Suspended  position,  65 
Swedish  movements,  63 

definition  of,  63 
Synovitis,  173 

Tabes,  129 

Tapotement,  18 

Temperature       of       operating 

room,  184 
Time  for  massage,  183 
Torticollis,  158 
Tumors,  massage  in,  62 
Turning,  100 
Typhoid  fever,  massage  in,  62 

Uterine  affections,  154 

Varicose  veins,  174 
Vibrations,  54 


Vibrations,  digital,  54 

of  abdomen,  56,  58 

of  arm,  54 

of  arms,  54 

of  bladder,  57 

of  eyes,  58 

of  head,  58 

of  heart,  144 

of  larynx,  58 

of  leg,  54 

of  liver,  56 

of  pharynx,  58 

of  pit  of  stomach,  56 

of  throat,  58 

palmar,  54 
Vibrators,  43 

Weiss,  139 
Writer's  cramp,  136 

Ziegenspeck,  53 


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